ComplicaÃÃes Imediatas em PuÃrperas Submetidas as Histerectomias por Sepse: ExperiÃncia de 17 anos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2004

RESUMO

In developed coutries, hemorrhage is the main cause for postpartum hysterectomy. However, in underdeveloped countries the main cause is sepsis, followed by hemorrhage. This study was conduted to evaluate the immediate complications of patients who were hysterectomized due to sepsis. A retrospective cohort was formed using data from the medical records of 139 patients who were hysterectomized in the Obstetric Unit of the Hospital das ClÃnicas of the Federal University of Pernambuco, between April 1985 and June 2002. According to the main indication, the patients were divided in two groups: infection group and hemorrhagic syndromes group (control group). Of the 139 hysterectomies performed, 86 (61.8%) were due to sepsis (SE) and 53 (38.1%) were due to hemorrhagic syndromes (HS). In both groups, the multipregnancy prevailed, 87.2% in SE group and 96.2% in the HS group. Regarding the mode of delivery, 66.3% of the hysterectomies in patients with SE and 92.5% of the patients with SH had a cesarean section (p=0.0003 and p<0.0001, respectively). In the SH group, placental abruption prevailed (p<0.001). A total hysterectomy was perfomed in 97.7%% of the patients in the SE group (p<0.001), whereas only 45.3% in the HS group were total hysterectomies (p<0.001). The patients hysterectomized due to sepsis received more blood transfusions than the control group (60.5 x 45.3%), with no statistical significance. None of the patients in the HS group presented complications during the surgical procedure. However, 9.3% of the patients in the sepsis group presented some sort of complication during the surgery (damages to the digestive tract, urinary tract and clotting disorder). Regarding the postoperative complications, it was observed that 31.4% of the SE group presented complications due to infection (necrotizing faciitis, renal failure, shock septic and respiratory arrest) â none of them were observed in patients with hemorrhagic syndromes. The septic patients showed a higher rate of abscess (intraabdominal and surgical site than the HS group (p<0.05). A hysterectomy in the presence of puerperal infection increases the maternal morbimortality in puerperium, with a higher rate of complications when compared to the patients with hemorrhagic syndromes

ASSUNTO(S)

sepse puÃrperas â complicaÃÃes cirurgia puÃrperas â complicaÃÃes imediatas

ACESSO AO ARTIGO

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