Revista Chilena de Obstetricia y Ginecología (Jan 2006)
HISTERECTOMÍA OBSTÉTRICA EN EL HOSPITAL DE PUERTO MONTT, 2000-2005
Abstract
Se presenta la revisión de 25 pacientes con histerectomía obstétrica (HO) periparto ocurridas en el Hospital de Puerto Montt en el período 2000 - 2005. En 24 casos (96%) el parto fue por operación cesárea. El riesgo de HO periparto es 56 veces mayor en los partos cesárea que en los partos vaginales. Las principales causas de interrupción fueron cicatriz de 2 o más cesáreas en las cesáreas electivas y en las cesáreas urgentes la metrorragia del tercer trimestre. La principal causa clínica de HO es el acretismo placentario en 12 casos (48%) seguido de atonía uterina en 8 casos (32%). El estudio histológico se hizo en el 76% de los casos de los cuales el 80% confirma acretismo placentario. La HO total se realizó en 13 casos (52%) y subtotal en 12 casos (48%). El tiempo operatorio promedio fue de 124,3 ± 37,8 minutos. El hematocrito post operatorio tiene un descenso menor en las pacientes con HO subtotal que en la total (pWe present a clinical review of 25 patients with peripartum obstetric hysterectomy over a six year (2000 -2005) in Puerto Montt Hospital (Chile). The overall incidence of peripartum obstetric hysterectomy was 1.15 per 1.000 deliveries. 24 (96%) of them were cesarean section. The Odd Ratio of peripartum obstetric hysterectomy is 56 time higher in cesarean than in vaginal birth. The main indication for elective operative delivery was two or more previous cesarean section and 3rd trimester bleeding for emergency cesarean section. The most common clinical indication for peripartum obstetric hysterectomy was placenta accreta in 12 cases (48%) and uterine atony in 8 cases (32%). Histologyc study was performed in 76% of cases, 80% of which had placenta accreta. Total obstetric hysterectomy was performed in 13 cases (52%) and subtotal hysterectomy in 12 cases (48%). The mean operative time was 124.3 ± 37.8 minutes. The post surgical hematocrit was lesser in subtotal than total hysterectomy (p< 0.05). The main operative complication was bladder injury in 4 patients (16%), more frequent in total hysterectomy than subtotal hysterectomy (3:1), without significant difference. There was no maternal mortality associated with obstetric hysterectomy, but 3 infant died due acute fetal distress associated to 3rd trimester bleeding and 1 to chorioamnionitis
