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Abstract(s)
Histerectomia pós-parto (HPP) é um procedimento raramente utilizado na obstetrícia
moderna, realizado apenas aquando hemorragia obstétrica massiva, refratária a
tratamentos conservadores, de forma a evitar um desfecho trágico- a morte materna.
As indicações primárias mais frequentes para a realização de HPP são atonia e rutura
uterina. Com a evolução dos cuidados intraparto e dos tratamentos de controlo/ gestão da
atonia, a incidência destes tem vindo a decrescer. Anormalidades placentárias têm vindo a
emergir como as principais indicações de HPP nos países desenvolvidos, atribuído
essencialmente ao crescimento da taxa de cesariana e outros procedimentos ginecológicos
como curetagem, miomectomia, entre outros.
Nesta presente dissertação é descrito um caso clínico de uma mulher grávida que realizou
no CHUCB uma cesariana eletiva às 38 semanas gestacionais por diagnóstico de placenta
prévia. Posteriormente à cirurgia, ocorreu uma hemorragia vaginal súbita e excessiva, com
queda de valores tensionais, apenas com melhoria parcial destes, mesmo após o recurso
de várias medidas farmacológicas. Tratando-se de uma hemorragia uterina pós-cesariana
em quadro de atonia uterina grave e refratária a medidas terapêuticas, recorreu-se a
histerectomia total como recurso de última linha de atuação perante um quadro de choque
hemorrágico de súbita instalação. Este procedimento permitiu o controlo da hemorragia
ativa, recuperando as capacidades vitais desta utente.
Foi realizada uma revisão de literatura, no sentido de investigar a importância do estudo
de potenciais situações/fatores que possam predispor a utente a um distúrbio placentário
e/ou hemorragia maciça incontrolável que através de uma HPP emergente é possível
evitar a morte materna.
Postpartum hysterectomy (PPH) is a procedure rarely used in modern obstetrics, performed only when massive obstetric hemorrhage, refractory to conservative treatments, in order to avoid a tragic outcome - maternal death. The most frequent primary indications for the realization of PPH are atony and uterine rupture. With the evolution of intrapartum care and atony control / management treatments, their incidence has been decreasing. Placental abnormalities have emerged as the main indications for PPH in developed countries, mainly attributed to the increase in the rate of cesarean section and other gynecological procedures such as curettage, myomectomy, among others. This dissertation describes a clinical case of a pregnant woman who underwent an elective cesarean section at CHUCB at 38 gestational weeks due to a diagnosis of placenta previa. Subsequent to the surgery, there was a sudden and excessive vaginal hemorrhage, with a drop in tension values, with only partial improvement, even after the use of several pharmacological measures. In the case of a post-cesarean uterine hemorrhage in severe uterine atony and refractory to therapeutic measures, total hysterectomy was used as a last resort in the face of a sudden onset of hemorrhagic shock. This procedure allowed the control of active bleeding, recovering the vital capacities of this patient. A literature review was carried out in order to investigate the importance of studying potential situations / factors that may predispose the patient to a placental disorder and / or massive uncontrollable hemorrhage that, through an emerging PPH, it is possible to avoid the maternal death.
Postpartum hysterectomy (PPH) is a procedure rarely used in modern obstetrics, performed only when massive obstetric hemorrhage, refractory to conservative treatments, in order to avoid a tragic outcome - maternal death. The most frequent primary indications for the realization of PPH are atony and uterine rupture. With the evolution of intrapartum care and atony control / management treatments, their incidence has been decreasing. Placental abnormalities have emerged as the main indications for PPH in developed countries, mainly attributed to the increase in the rate of cesarean section and other gynecological procedures such as curettage, myomectomy, among others. This dissertation describes a clinical case of a pregnant woman who underwent an elective cesarean section at CHUCB at 38 gestational weeks due to a diagnosis of placenta previa. Subsequent to the surgery, there was a sudden and excessive vaginal hemorrhage, with a drop in tension values, with only partial improvement, even after the use of several pharmacological measures. In the case of a post-cesarean uterine hemorrhage in severe uterine atony and refractory to therapeutic measures, total hysterectomy was used as a last resort in the face of a sudden onset of hemorrhagic shock. This procedure allowed the control of active bleeding, recovering the vital capacities of this patient. A literature review was carried out in order to investigate the importance of studying potential situations / factors that may predispose the patient to a placental disorder and / or massive uncontrollable hemorrhage that, through an emerging PPH, it is possible to avoid the maternal death.
Description
Keywords
Atonia Uterina Complicações Desfecho Materno Hemorragia Pós-Parto Histerectomia Pós-Parto