Ramírez-Cornelio M, Jiménez-Bonola A, Neri-Rubio E, Rodríguez-Pazos OJ, Rojas-Poceros G

Language: Spanish
References: 21
Page: 423-436
PDF size: 553.31 Kb.

ABSTRACT

Objective: To describe the Ramírez-Maksymenko technique (ligation of hypogastric, ovarian, Sampson arteries) and show that immediate pelvic computed tomography angiography favors the decrease in maternal morbidity and mortality due to obstetric hemorrhage.
Materials and Methods: Prospective study carried out between the months of May 2019 to March 2020. Patients with obstetric hemorrhage postoperated with the Ramírez-Maksymenko technique were included, with follow-up by pelvic computed tomography angiography and observation of the main arteries supplying the uterus, according to the time after surgery until returning to normal.
Results: Five patients were studied who, on postoperative pelvic computed tomography angiography, found adequate uterine vascularity through the arteries: medial sacral, iliolumbar, vaginal, and ovarian arteries. All patients returned to normal at ap- manioproximately 3 months 14 days. The diameter of the hypogastric patients the day after the postoperative period was 1 mm and at 3 months 14 days 4 mm (normal).
Conclusions: With this technique, massive transfusions, admission to intensive care, reduction of uterine vascularity are avoided, and a faster return to normal is favored. With this dearterialization technique, the uterus continues with adequate vascularity through the iliolumbar, middle sacral, vaginal, and branches of the ovarian arteries, despite being linked, which should happen with other surgical techniques where they are ligated. A single silk 1 or 2-0 chromic thread is sufficient to decrease the diameter of the hypogastric; some techniques use two sutures. In approximately 3 months and 14 days, the circulation returns to normal.

REFERENCES

1. PAHO/WHO initiative seeks to reduce maternal deaths from hemorrhage in the americas. https://www.paho. org/hq/index.php?option=com_content&view=article& id=10592:2015-pahowho-initiative-seeks-to-reduce-maternal- deaths-from-hemorrhage&Itemid=1926&lang=en

2. Committee on Practice Bulletins-Obstetrics. Postpartum Hemorrhage. ACOG practice bulletin No 183:, Oct 2017, 111(94), 1479–1485. https://doi.org/10.1097/ AOG.0000000000002351

3. Dirección General de Epidemiología (DGE). Muerte materna. Semana Epidemiológica 52. https://www.gob.mx/cms/ uploads/attachment/file/521458/MM_2019_SE52.pdf

4. Latarjet M, et al. Anatomía humana. 4ª ed. México: Panamericana, 2004; 1030-1036, 1627-1629. https://books. google.com.mx/books?id=5Rpr4aSnC5gC&printsec=fron tcover&hl=es#v=onepage&q&f=false

5. Recomendaciones de la OMS para la prevención y el tratamiento de la hemorragia posparto, OMS 2014. https://apps.who.int/iris/bitstream/handle/ 10665/141472/9789243548500_spa.pdf;jsessionid=1 10E5CAF0B7D7C7E7F15EE3A400F6588?sequence=1

6. WHO Recommendations: Uterotonics for the prevention of postpartum haemorrhage. Geneva: World Health Organization; 2018. https://apps.who.int/iris/bitstream/hand le/10665/277276/9789241550420-eng.pdf?ua=1

7. Heesen M, et al. International consensus statement on the use of uterotonic agents during caesarean section. Anaesthesia 2019; 74 (10):1305-19. https://doi. org/10.1111/anae.14757

8. Khelifi, A, et al. Therapeutic ligature of hypogastric arteries: color Doppler follow up. J Radiol 2000; 81: 607-10. https:// www.ncbi.nlm.nih.gov/pubmed/10844337

9. García-López A, et al. Técnica quirúrgica vascular integral avanzada (VIVA) aplicada en pacientes con placenta previa, anormalmente adherida con feto. Ginecol Obstet Mex. 2019; 87 (1): 36-45. https://doi.org/10.24245/gom. v87i1.2616

10. Unal O, et al. The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility. J Matern Fetal Neonatal Med. 2011; 24 (10): 1273-6. https:// doi.org/10.3109/14767058.2011.574751

11. Carranza-Lira S, et al. Efectos de la desarterialización uterina en el flujo sanguíneo uterino y ovárico. Rev Med Inst Mex Seguro Soc. 2018; 56 (2): 143-47. http://www.redalyc. org/articulo.oa?id=457754717004

12. Kelly. The Johns Hopkins Hospital Bulletin 5. Marzo 5, 1894; 53-54. https://babel.hathitrust.org/cgi/pt?id=uva.347008 5734&view=1up&seq=53&size=175

13. Burchell RC. Internal iliac artery ligation. Hemodynamics 1964; 24 (5). PMID: 14227607

14. Burchell RC, et al. Internal iliac artery ligation: Aortograms. Am J Obstet Gynecol. 1966; 94 (1): 117- 24. doi:10.1016/0002-9378(66)90388-7

15. Wagaarachchi PT, et al. Fertility following ligation of internal iliac arteries foe life-threatening obstetric heamorrhage. Hum Reprod. 2000; 15: 1311-3. doi:10.1093/ humrep/15.6.1311

16. Nizard J, et al. Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage. Hum Reprod. 2003; 18: 844-8. doi:10.1093/ humrep/deg161

17. Ghezzi F, et al. The Hayman technique: A simple method to treat postpartum haemorrhage. BJOG. 2007; 114 (3): 362-5. https://doi.org/10.1111/j.1471- 0528.2006.01204.x

18. AbdRabbo SA. Stepwise uterine devascularization: A novel technique for management of uncontrollable postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol. 1994; 171 (3): 694-700. doi: 10.1016/0002- 9378(94)90084-1

19. Benkirane S, et al. Uterine necrosis following a combination of uterine compression sutures and vascular ligation during a postpartum hemorrhage: a case report. Int J Surg Case Rep. 2017; 38: 5-7. doi: 10.1016/j.ijscr.2017.07.005

20. Joshi VM, et al. Partial ischemic necrosis of the uterus following a uterine brace compression suture. BJOG. 2004; 111 (3): 279-80. https://doi.org/10.1111/j.1471- 0528.2004.00056.x

21. Begum J, et al. B-Lynch: A technique for uterine conservation or deformation? A case report with literature review. J Clin Diagn Res. 2014; 8 (4): OD01-3. https://doi. org/10.7860/JCDR/2014/8139.4284