Objectives: To determine the incidence, associated factors and outcomes of obstetrical hysterectomy. Design: Retrospective, descriptive, analytical and cross-sectional study. Setting: Hospital Nacional Docente Madre Niño San Bartolome, Lima, Peru. Material: Clinical records of 69 patients who underwent obstetrical hysterectomy (OH) performed between January 1, 2003, and December 31, 2015. Methods: Odds ratio was applied as measure of association, and Excel 2013 and SPSS programs were used for statistical analysis. Main outcome measures: Incidence, associated factors and outcomes of obstetrical hysterectomy. Results: OH rate was 0.69/1 000; 82.6% followed cesarean section delivery (1.94/1 000), OR cesarean section/vaginal delivery was 19.91; 65.2% were multiparous women aged 35 or less, 78.2% with prenatal control. Main diagnoses were placenta previa (27.5%) and previous cesarean section...

Placenta accreta spectrum (PAS) is an abnormal placentation that causes unexpected severe postpartum hemorrhage and high morbidity and mortality. Treatment is surgical and hysterectomy has been the first option for decades; however, in the last few years, surgical alternatives try to avoid the severe complications of hysterectomy while preserving woman’s fertility. We performed a review of controlled, randomized and observational studies of PAS, with emphasis on therapeutic alternatives. PAS surgical management is a real challenge and merits multidisciplinary and preventive care. Emergency hysterectomy is still the first option in cases of severe hemorrhage and hemodynamic instability, but conservative management is a valid alternative at patient’s request, if she gives her informed consent and there is no hemodynamic compromise. The existence of multiple surgical and conservative al...

Hepatic subcapsular hematoma is a rare and lethal complication of HELLP syndrome presenting during pregnancy or the postpartum in women with severe preeclampsia or eclampsia. Maternal and perinatal mortality is high, hence the importance of prevention, early recognition, and timely and multidisciplinary treatment. We present a case of spontaneous rupture of subcapsular hepatic hematoma in which treatment consisted in electrofulguration and placement of hemostatic mesh, and a review of the literature.

Abdominal ectopic pregnancy is a dramatic situation for the woman’s health. It is a rare pathology that proves to be a difficult test even for the most experienced gynecologists in diagnostic ability, decision-making and surgical technique. We present the case of a hospitalized post-term ectopic abdominal pregnancy with a dead fetus inside the chorioamniotic sac and the placenta implanted on vital abdominal viscera. We describe the clinical data, operative findings and conservative management of the retained placenta, followed by a bibliographic review on the subject.

Introduction: Placenta accreta spectrum (PAS) refers to pathological adhesions of the placenta to the uterus. It is considered a public health problem due to its increase in recent decades, and it is associated with significant maternal morbidity and mortality and high risk of hemorrhage, blood transfusions and hysterectomy. Objective: To determine the epidemiological, surgical and post-surgical characteristics of patients with placenta accreta. Methods: Descriptive, retrospective study of patients with placenta accreta spectrum attended at San Bartolomé Hospital, Lima, Peru, between 2014 and 2018. Results: Thirty-six PAS cases were documented with a birth rate of 1.2/1 000; 94% occurred in multiparous women, 81% had previous uterine surgery including 26 (72%) with previous cesarean section; 61% were 35 years old or older, and 47% had placenta previa. Treatment was conservative in 53% o...

Con la finalidad de conocer los factores que determinan la demanda de atención ginecológica en el Hospital San Bartolomé, se realiza el presente estudio cualitativo, descriptivo, prospectivo, transversal, correlacional, recogiendo información en base a encuestas realizadas a 460 pacientes de tres estratos diferentes (61 pacientes ginecológicas, 215 pacientes obstétricas, y 184 pacientes de los Centros de Salud del ámbito de influencia), a datos estadísticos del Departamento de Gineco-Obstetricia y a la opinión de los médicos del Departamento en relación al tema, según cuestionario aplicado. El 75.34% de las pacientes obstétricas reconocen al San Bartolomé como un Hospital que atiende principalmente problemas del embarazo y niños (Hospital Materno-Infantil) y hay quienes lo consideran inclusive exclusivamente como Maternidad (6.51%). Igualmente el 48.28% de las pacientes de...

HELLP syndrome (HS) is a severe complication of pregnancy characterized by hemolysis, elevated liver enzymes and low platelets. It is one of the most serious maternal complications and is associated with high maternal and perinatal morbidity and mortality. Childbirth is the only effective treatment against HS. The most frequent complication of HS is hemorrhage, requiring blood transfusions and/or blood products to correct hypovolemia, anemia or coagulopathy; spontaneous liver hematoma is the most catastrophic problem. Perinatal mortality is directly related to gestational age. There is no consensus on HS management occurring before 34 weeks of gestation when maternal and fetal conditions are stable. The purpose of this review is to summarize the existing information about the timely management of HS. It is concluded that the birth route will depend on cervical conditions and maternal and...

Introduction: HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and thrombocytopenia; it is one of the most serious maternal complications of pregnancy, with significant morbidity and mortality, and high risk of renal failure, hepatic hematoma, disseminated intravascular coagulopathy and receiving multiple blood transfusions. Objective: To describe the clinical presentation, diagnosis, complications and management of patients with HELLP syndrome in a Peruvian hospital. Method: Descriptive, retrospective study of cases with HELLP syndrome at a Peruvian hospital. Results: Out of 30 618 deliveries, 71 cases of HELLP syndrome were found, with an incidence of 0.23%; 68% of cases were multiparous, with an average age of 33. Diagnosis was confirmed during pregnancy in 46% (58% of them developed HELLP syndrome before 37 weeks of gestation) and in the puerperium in 54%. Matern...

Objectives: To determine the incidence, epidemiological and clinical characteristics and medical-surgical management of patients with spontaneous hepatic hematoma (SHH) associated to the HELLP syndrome. Design: Descriptive, retrospective series of cases. Institution: Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru. Participants: Women diagnosed with SHH. Interventions: Review of medical records of patients with SHH attended in the period May 2014 - May 2018. Results: We found eight cases of SHH, with an incidence of 1/3 632 births. The average maternal age was 32 years; all of them were multiparous, 62.5% with full-term pregnancies. The most frequent symptom was epigastric pain. Initial diagnosis of severe preeclampsia was determined in 62.5% of the cases, and all of them progressed to HELLP syndrome. Intracesarean SHH occurred in 37.5% of the cases and 62.5% presented i...