Suturas Compressivas Uterinas na abordagem terapêutica da Hemorragia Pós-parto por Atonia Uterina

• Autor(a) principal: Ana Luísa de Sá Almeida
• Data de Publicação: 2022
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10216/142182
• topic: Medicina clínica; Clinical medicine

Postpartum hemorrhage (PPH) has a prevalence of 6% and represents an important cause of maternal morbimortality worldwide, having as its main cause the uterine atony (80%). Since the publication of the first hemostatic suture, applied in a uterine atony in 1997, several variations have been described: need for hysterotomy, uterine endocavitary suture threads, transverse sutures complementary to the original longitudinal sutures, association with vascular surgical ligation and use of removable sutures in the early postpartum period. The main goal is to optimize the therapeutic success in the control of postpartum hemorrhage, turning the technique more feasible and, simultaneously, minimizing the risks/complications associated at short and long term. The pathophysiological mechanism underlying the effectiveness of these sutures is based on the myometrial contractility increase, mechanical compression of the uterine vascular space and placental bed, maintaining arterial vascular patency without occlusion of the uterine cavity. Although the suture material constitutes an important factor of success technique and, as well, of morbidity, the literature remains sparse about the type of thread and needle used. The limitations of the studies regarding the low scientific quality, small sample size, heterogeneity of technique, non-standardization of the evaluated outcomes, do not allow to accurately determine the rate of short and long-term complications such as: infectious risk, menstrual disorders, pelvic pain and herniation through the loops. Regarding the impact on future fertility there were no significant differences on incidence of placenta previa, placenta accreta, preeclampsia, preterm delivery and fetal growth restriction. However, there is no doubt about the success rate, which is around 75 to 100%.