[Modification to surgical technique of cesarean hysterectomy].

BACKGROUND

Bleeding is a significant cause of maternal mortality in the world. Obstetric hysterectomy increases maternal morbidity and mortality.

OBJECTIVES

To describe a modified technique of cesarean-hysterectomy to limit bleeding during surgery in cases of placenta accreta and placenta previa, which consist of hypogastric artery ligation before the removal of the uterus. Another objective of this study is to compare maternal outcomes of patients undergoing this technique with the usual technique.

PATIENTS AND METHOD: Comparative, longitudinal, closed stydy. We analyzed the records of 86 patients undergoing cesarean-hysterectomy surgery, from July 1, 2008 to July 31, 2009, were programmed 29 patients with the modified technique and 57 with the usual. The main outcomes analyzed were: estimated bleeding during surgery, number of packed red blood cells and plasma units transfused and hospital stay in intensive care.

RESULTS

Bleeding during surgery, blood transfusion and admission to intensive care demand, and hospital stay were significantly lower in patients with the modified technique. Also there were fewer trans and postoperative complications in this group.

CONCLUSIONS

The results of this study show that the modified technique of cesarean-hysterectomy derives significant reduction of maternal morbidity, less massive transfusions demand to manage intensive care units.