Juárez BI, Herrera VJE

Language: Spanish
References: 15
Page: 10-14
PDF size: 578.26 Kb.

ABSTRACT

Introduction: primary postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Vaginal clamping of uterine arteries is an effective alternative for PPH control in resource-limited settings. Objective: to describe the experience with vaginal clamping in PPH at a hospital without an on-site blood bank. Material and methods: an observational, descriptive, and retrospective study. Twenty-two cases involving vaginal clamping of uterine arteries were analyzed out of 53 PPH records at Valle de Bravo General Hospital (January-December 2023). Results: the mean age was 22.2 years (68.1% under age 25), with 88% being full-term pregnancies. Predominant risk factors included preeclampsia, gestational diabetes, and anemia. Uterine atony was the main cause of PPH and the primary indication for clamping. The mean clamping time was 6 hours. Hypovolemic shock grade II-III was present in 36.3% of patients, with an average blood volume loss of 33.5%. Conclusions: the incidence of PPH was 0.6%, lower than reported in the literature. Vaginal clamping of uterine arteries is an effective and reproducible option to decrease bleeding volume and reduce maternal morbidity in hospitals lacking a blood bank.

REFERENCES

1. World Health Organization. Maternal mortality: Evidence brief. Geneva: WHO; 2023.

2. Secretaría de Salud (MX). Informe Semanal deVigilancia Epidemiológica: Mortalidad Materna,Semana Epidemiológica 52. Ciudad de México:Dirección General de Epidemiología; 2023.

3. Escobar MF, Nassar AH, Theron G, Barnea ER, NicholsonS, Ramasauskaite D et al. Postpartum hemorrhage:New insights for definition and management. Rev BrasGinecol Obstet. 2022; 44 (11): 1012-1017.

4. Sentilhes L, Weiniger CF, Deneux-Tharaux C, Javier H,Al-Khatari S, Al-Widian R et al. Postpartum hemorrhage:FIGO/ICM guidelines. Int J Gynaecol Obstet. 2021; 154(S1): 4-11.

5. Wormer KC, Jamil RT, Bryant SB. Postpartumhemorrhage. Treasure Island (FL): StatPearlsPublishing; 2023.

6. Gallos ID, Williams HM, Price MJ, Merriel A, Gee H,Lissauer D et al. Uterotonic agents for preventingpostpartum haemorrhage: a network meta-analysis.Cochrane Database Syst Rev. 2019; 4 (4): CD011689.

7. Widmer M, Piaggio G, Nguyen TMH, Osoti A, Owa OO,Misra S et al. Heat-stable carbetocin versus oxytocinfor postpartum hemorrhage prevention. N Engl J Med.2018; 378 (26): 2482-2491.

8. Parry S, Meyer CA, Kumar S. Management ofpostpartum hemorrhage: a review of strategy anddrugs. J Clin Med. 2022; 11 (16): 4723.

9. Suarez S, Conde-Agudelo A, Portela-House A, Mella MT,Wright D, Espitia-De La Hoz FJ et al. Uterine balloontamponade for postpartum hemorrhage: a systematicreview. Am J Obstet Gynecol. 2020; 222 (4): 293.e1-293.e52.

10. Abalos E, Giugliani C, García-Elorrio E, Vais A, LedeR, Anyagaligbo O et al. FIGO recommendationson management of postpartum hemorrhage. Int JGynaecol Obstet. 2021; 152 (3): 312-317.

11. García-Pineda A, Pérez-Mendoza J, Morales-RíosO. Técnica de Zea: una alternativa vigente en lahemorragia obstétrica. Rev Mex Obstet Ginecol. 2021;89 (5): 342-348.

12. Bautista-Gómez E, Martínez-López L, Reyes-Cruz G.Pinzamiento vaginal de arterias uterinas en hemorragiapostparto. J Health Med Sci. 2020; 6 (3): 145-151.

13. Mendoza-Calderón S, Valerio-Castro E, Luna-MagañaM. Efectividad del pinzamiento de arterias uterinas(Técnica de Zea). Ginecol Obstet Mex. 2022; 90 (4):315-322.

14. World Health Organization. WHO recommendations onnon-drug interventions for postpartum hemorrhage.Geneva: WHO; 2020.

15. López-Morales SM, Martínez-Ramírez R, Sánchez-LópezG. Manejo de hemorragia obstétrica en hospitales desegundo nivel sin banco de sangre. Rev Sanid Milit.2023; 77 (1): 12-19.