Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 6 , ISSUE 1 ( January-April, 2017 ) > List of Articles

ORIGINAL ARTICLE

Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia

Carlos A Ordóñez, Albaro J Nieto, Javier A Carvajal, Juan M Burgos, Adriana Messa, Angélica M Forero, José D Casallas, Laura S Thomas, María F Escobar

Citation Information : Ordóñez CA, Nieto AJ, Carvajal JA, Burgos JM, Messa A, Forero AM, Casallas JD, Thomas LS, Escobar MF. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017; 6 (1):1-7.

DOI: 10.5005/jp-journals-10030-1164

License: CC BY 3.0

Published Online: 01-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective

The aim of this case series is to describe the experience of implementing damage control resuscitation (DCR) in patients with major obstetric hemorrhage (MOH) between January 2005 and December 2015 in the Fundación Valle del Lili, Cali, Colombia.

Materials and methods

This is a prospective descriptive study of a case series from 108 patients with MOH who were subjected to DCR. All patients were operated on using a standardized surgical technique in accordance with the institutional protocol.

Results

The median age was 28 years, with a gestational age of 38 weeks. The principal associated diagnosis was severe preeclampsia (in 39% of cases). A total of 96 patients presented massive postpartum hemorrhage, and 75% of these cases presented after a cesarean section. In all patients, normal control of bleeding was achieved, 60% during the first surgical period. The Acute Physiology and Chronic Health Evaluation score was 14, with an overall mortality of 6.48%, far below the expected mortality according to the clinical severity of these patients.

Conclusion

This study includes the biggest series of pregnant women with MOH, in a critical condition, in whom DCR was used, during which rapid control of bleeding was achieved, associated with a significantly lower mortality than expected.

How to cite this article

Escobar MF, Carvajal JA, Burgos JM, Messa A, Ordoñez CA, García AF, Granados M, Forero AM, Casallas JD, Thomas LS, Nieto AJ. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017;6(1):1-7.

Objetivo

El objetivo de esta serie de casos es describir la experiencia de la aplicación de la CCD (Cirugía de control de daños) en pacientes con hemorragia obstétrica mayor (HOM) entre enero del 2005 y diciembre del 2015 en la Fundación Valle del Lili, Cali, Colombia.

Métodos

Estudio descriptivo prospectivo de una serie de casos de 108 pacientes con HOM sometidas a CCD. Todas las pacientes fueron operadas usando una técnica quirúrgica estandarizada, acorde al protocolo institucional.

Resultados

La mediana de edad fue de 28 años, con edad gestacional de 38 semanas. El diagnosticó principal asociado fue pre eclampsia severa (en 39% de los casos). 96 presentaron hemorragia postparto masiva (HPP) y el 75% de los casos se presento después de cesárea. En todas las pacientes se logro el control del sangrado, 60% en el primer tiempo quirúrgico. El APACHE II promedio fue de 14 con una mortalidad global de 6,48%, muy por debajo de la mortalidad esperada para la severidad clínica de estas pacientes.

Conclusiones

Este estudio incluye la serie más grande de gestantes con HOM en condiciones críticas, en quienes se utilizó CCD, con rápido control del sangrado, asociado a una mortalidad considerablemente menor a la esperada.

Palabras Clave

Choque hipovolémico, Cuidados intensivos quirúrgicos, Hemorragia postparto, Tratamiento de urgencia.


  1. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 2015;387(10017):462-474.
  2. Obstetric admissions to the intensive care unit. Obstet Gynecol 1999 Aug;94(2):263-266.
  3. Massive blood loss and transfusión in obstetrics and gynecology. Obstet Gynecol Surv 2005 Dec;60(12):827-837.
  4. Experience with a massive transfusion protocol in the management of massive haemorrhage. Transfus Med 2013 Apr;23(2):108-113.
  5. Damage control in abdominal trauma. Contemp Surg 2006;62:65-74.
  6. A prospective look at the current state of open abdomens. Am Surg 2008 Oct;74(10):891-897.
  7. The 1 2 3 approach to abdominal packing. World J Surg 2012 Dec;36(12):2761-276.
  8. Vacuum pack technique of temporary abdominal closure. A 7 year experience with 112 patients. J Trauma 2000 Feb;48(2):201-206.
  9. An effective pressure pack for severe pelvic hemorrhage. Obstet Gynecol 2006 Nov;108(5):1222-1226.
  10. Surgical packing as a means of controlling massive haemorrhage in association with advanced abdominal pregnancy. Eur J Obset Gynecol Reprod Biol 2003 Jul;109(1):106-107.
  11. Abdominal packing for intractable obstetrical and gynecologic hemorrhage. Int J Gynecol Obstet 2006 May;93(2):160-163.
  12. Cirugía de control de daños: Un concepto aplicable en ginecología y obstetricia. Colombia Méd 2005;36(2):110-114.
  13. Damage control and the open abdomen: challenges for the nonsurgical intensivist. J Intensive Care Med 2016 Oct;31(9):567-576.
  14. Total management of the open abdomen. Int Wound J 2012 Aug;9(Suppl 1):17-24.
  15. Impacto de la cirugía de control de daños en las emergencias hemorrágicas intraabdominales ginecológicas. Rev Arg Cirug 2008;94(1-2):29-28.
  16. Temporary closure of open abdominal wounds: the vacuum-pack. Am Surg 1995 Jan;61(1):30-35.
  17. Management of the open abdomen: a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg 2013 Jun;257(6):1154-1159.
  18. Independent contributions of hypothermia and acidosis to coagulopathy in swine. J Trauma 2005 May;58(5):1002-1009.
  19. APACHE II: a severity of disease classification system. Crit Care Med 1985 Oct;13(10):818-829.
  20. Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. Am J Surg 1990 Nov;160(5):515-518.
  21. Damage control surgery in the era of damage control resuscitation. Br J Anaesth 2014 Aug;113(2):242-249.
  22. Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl 1):1-203.
  23. Temporal trends and determinants of peripartum hysterectomy in Lombardy, Northern Italy, 1996–2010. Arch Obstet Gynecol 2013 Feb;287(2):223-228.
  24. Management of the open abdomen. Surg Clin North 2014 Feb;94(1):131-153.
  25. New approaches to obstetric hemorrhage: the postpartum hemorrhage con-sensus algorithm. Curr Opin Anaesthesiol 2014;27(3):267-274.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.