Pérdida sanguínea y uso de hemoderivados en casos de cesárea e histerectomía por acretismo placentario

Abstract

BackgroundPlacenta accreta is a pathology that is associated with an elevated risk of haemorrhage, thus endangering the life of the obstetric patients. It is a public health problem, due to maternal morbidity and mortality.There are multiple lines of management; however caesarean hysterectomy is the method of choice to resolve a pregnancy with placental accreta.It is a procedure of high risk, even as a programmed surgery. The surgical and medical teams are challenged by the risk of massive haemorrhage and need to have rapid access to blood products to maintain haemostasis and haemodynamic balance. ObjectiveTo quantify blood loss, as well as the amount of blood derivatives used in patients in whom a caesarean hysterectomy was required due to placenta accreta. Material and methodsA cross-sectional study was conducted that included patients that required a caesarean hysterectomy due to placenta accreta within a period of 4 years. ResultsA total of 106 cases of placenta accreta were studied, with 64.15% of the patients having a history of abortion and curettage, and 76.41% had at least 1 caesarean section. The mean blood loss was 2523.87 millilitres, with over 23.5% having a massive haemorrhage (> 3000 cc). Red blood cells transfusions were necessary in 68.98% of the cases. Fresh frozen plasma was given to 29.24% of the patients, and platelet concentrates were used in 6.6% of the cases. ConclusionsTimely detection of placenta accreta in patients, an adequate surgical technique and experience, as well as the use of blood derivatives, are the cornerstones in the management of this disease.