title: [Modification to surgical technique of cesarean hysterectomy].
abstract: BACKGROUND
  Bleeding is a significant cause of maternal mortality in the world. Obstetric hysterectomy increases maternal morbidity and mortality.
  
  
  OBJECTIVE
  To describe a modified technique of cesarean-hysterectomy to limit bleeding during surgery in cases of placenta accreta and placenta previa, which consist of hypogastric artery ligation before the removal of the uterus. Another objective of this study is to compare maternal outcomes of patients undergoing this technique with the usual technique.
  
  
  METHODS
  Comparative, longitudinal, closed stydy. We analyzed the records of 86 patients undergoing cesarean-hysterectomy surgery, from July 1, 2008 to July 31, 2009, were programmed 29 patients with the modified technique and 57 with the usual. The main outcomes analyzed were: estimated bleeding during surgery, number of packed red blood cells and plasma units transfused and hospital stay in intensive care.
  
  
  RESULTS
  Bleeding during surgery, blood transfusion and admission to intensive care demand, and hospital stay were significantly lower in patients with the modified technique. Also there were fewer trans and postoperative complications in this group.
  
  
  CONCLUSIONS
  The results of this study show that the modified technique of cesarean-hysterectomy derives significant reduction of maternal morbidity, less massive transfusions demand to manage intensive care units.
authors.affiliation: División de Ginecología, Unidad Médica de Alta Especialidad, Hospital de Gineco-Obstetricia, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México. emig_2001@hotmail.com
authors.forename: Emigdio
authors.initials: E
authors.lastname: Torres-Farías
authors.forename: Luis Guillermo
authors.initials: LG
authors.lastname: Torres-Gómez
authors.forename: Ana María
authors.initials: AM
authors.lastname: Barba-Bustos
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vidal-Silva
authors.forename: Adriana Patricia
authors.initials: AP
authors.lastname: Vázquez-Vargas
mesh_terms: D000293:Adolescent; D000328:Adult; D001158:Arteries; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000379:methods*; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008026:Ligation; D011247:Pregnancy; D013536:Suture Techniques; D014592:Uterine Hemorrhage / Q000517:prevention & control; D014599:Uterus / Q000098:blood supply; D055815:Young Adult