Histerectomía posparto: Experiencia de Clínica Las Condes

Abstract

Objetive: To analyze the clinical experience of peripartum hysterectomy (PH). Method: Retrospective review of women who required PH at Las Condes Clinic since January 2000 to December 2009. Results: In the study period 15,356 patients were delivered with 34 cases of PH (incidence: 2.2/1000 deliveries). The mean age was 36 years old, 97% were multiparous. The mean gestational age at delivery was 36.1 weeks (range: 27-40). Causes: placenta accreta (61.8%), uterine atony (20.6%) and uterine rupture (8.8%). In 29.4% a bilateral hypogastric ligation was added to the hysterectomy. Total hysterectomy was performed in 85.3% of cases. There was at least one complication in 91.2% women. The intraopertive bladder injury associated with placenta accreta was the most frequent complication (26.5%). Postoperative complications: 29 cases of anemia, 10 cases of disseminated intravascular coagulopathy, 2 hemoperitoneum that required surgical reexploration, 2 cases of hypovolemic shock, 1 case of pelvic thrombosis, 1 case of ovarian vein thrombosis and 1 case of necrotizing fasceitis. Late complications included depression, pulmonary embolism, bladdervagina fistula and pelvic inflammatory disease. 76.5% required transfusion. There were no cases of maternal death with 8.5% of perinatal death. Conclusions: PH it is performed in patients with severe bleeding during or after labor and delivery, frequently is associated with serious maternal morbidity. Previous cesarean section with abnormal placental implantation and uterine atony were the most frequent indications.