<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0300-9041</journal-id>
<journal-title><![CDATA[Ginecología y obstetricia de México]]></journal-title>
<abbrev-journal-title><![CDATA[Ginecol. obstet. Méx.]]></abbrev-journal-title>
<issn>0300-9041</issn>
<publisher>
<publisher-name><![CDATA[Federación Mexicana de Colegios de Obstetricia y Ginecología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0300-90412020001000675</article-id>
<article-id pub-id-type="doi">10.24245/gom.v88i10.4347</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Morbilidad y mortalidad asociadas con protocolos de transfusión masiva en hemorragia obstétrica severa]]></article-title>
<article-title xml:lang="en"><![CDATA[Morbidity and mortality associated with mass transfusion protocols in severe obstetric hemorrhage]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez-Martínez]]></surname>
<given-names><![CDATA[Crescencio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aguirre-Villanueva,]]></surname>
<given-names><![CDATA[Natzul]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cepeda-Nieto]]></surname>
<given-names><![CDATA[Ana Cecilia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Autónoma del Estado de México  ]]></institution>
<addr-line><![CDATA[Toluca Estado de México]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Autónoma del Estado de Coahuila  ]]></institution>
<addr-line><![CDATA[ Coahuila]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<volume>88</volume>
<numero>10</numero>
<fpage>675</fpage>
<lpage>685</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0300-90412020001000675&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0300-90412020001000675&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0300-90412020001000675&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  OBJETIVO: Determinar la morbilidad y mortalidad debidas a la aplicación de protocolos de transfusión masiva en pacientes con hemorragia obstétrica atendidas en cuidados intensivos.  MATERIALES Y MÉTODOS:  Estudio de una cohorte retrospectiva de pacientes con hemorragia obstétrica severa atendidas en la unidad de cuidados intensivos obstétricos del Hospital Materno Infantil del Instituto de Seguridad Social del Estado de México y Municipios, entre septiembre de 2014 y mayo de 2019. Se compararon tres protocolos de transfusión masiva en los que se aplicaron los derivados de la sangre en relación con la proporción de concentrado eritrocitario, de plaquetas y plasma con las siguientes proporciones: 2:1:1, 1:1:1 y liberal. Para analizar la posible asociación de las complicaciones con la elección de los diferentes protocolos de transfusión masiva, se utilizó un análisis mediante prueba ANOVA y &#967;2 en el programa SPSS versión 21; se consideró significativo el valor de p &lt; 0.05.  RESULTADOS:  Se analizaron 75 pacientes con edad promedio de 32.8 años; 63 eran multigestas. La causa principal de la hemorragia obstétrica fue la atonía uterina. 51 de 75 de los protocolos de transfusión masiva fueron liberales, 11 de ellos con una relación 2:1:1 y 4 de 51 de 1:1:1. Las complicaciones fueron: síndrome de insuficiencia respiratoria aguda, lesión renal aguda, lesión renal aguda originada por la transfusión, infecciones y reintervención quirúrgica. Se encontró asociación positiva con: los días de estancia en cuidados intensivos (p = 0.031), reintervención quirúrgica (p = 0.006) y síndrome de insuficiencia respiratoria aguda (p = 0.044) y los protocolos de transfusión masiva liberal respecto de los protocolos con relación 1:1:1. Solo una paciente falleció y ello se asoció con el protocolo de transfusión masiva liberal.  CONCLUSIONES:  La aplicación de protocolos de transfusión masiva 1:1:1 y 2:1:1 en pacientes con hemorragia obstétrica severa disminuye el riesgo de complicaciones. La mortalidad materna debido a la aplicación del protocolo de transfusión masiva liberal fue de solo un caso en 51 pacientes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  OBJECTIVE: To determine the morbidity and mortality due to the application of massive transfusion protocols in patients with obstetric hemorrhage treated in intensive care.  MATERIALS AND METHODS: study of a retrospective cohort of patients with severe obstetric hemorrhage treated in the obstetric intensive care unit of the maternal and child hospital of the social Security Institute of the State of Mexico and municipalities, between september 2014 and may 2019. three massive transfusion protocols were compared in which blood derivatives were applied in relation to the ratio of erythrocyte concentrate, platelets and plasma with the following ratios: 2:1:1, 1:1:1 and liberal. to analyze the possible association of complications with the choice of the different mass transfusion protocols, an anova and &#967;2 test was used in the spss version 21 program; the value of p &lt; 0.05 was considered significant.  RESULTS: Seventy-five patients with a mean age of 32.8 years were analyzed; 63 were multigrafted. The main cause of obstetric bleeding was uterine atony. 51 of 75 of the mass transfusion protocols were liberal, 11 of them with a 2:1:1 ratio and 4 of 51 of 1:1:1. The complications were: acute respiratory failure syndrome, acute renal injury, acute renal injury originated by transfusion, infections and surgical reintervention. Positive association was found with: days of stay in intensive care (p = 0.031), surgical reintervention (p = 0.006) and acute respiratory failure syndrome (p = 0.044) and liberal mass transfusion protocols with respect to 1:1:1 ratio protocols. Only one patient died and this was associated with the liberal mass transfusion protocols.  CONCLUSIONS: The application of 1:1:1 and 2:1:1 mass transfusion protocols in patients with severe obstetric hemorrhage decreases the risk of complications. Maternal mortality due to the application of liberal mass transfusion protocols was only one case in 51 patients.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Transfusión masiva]]></kwd>
<kwd lng="es"><![CDATA[hemorragia obstétrica]]></kwd>
<kwd lng="es"><![CDATA[cuidados intensivos]]></kwd>
<kwd lng="es"><![CDATA[seguridad social]]></kwd>
<kwd lng="es"><![CDATA[eritrocitos]]></kwd>
<kwd lng="es"><![CDATA[plaquetas]]></kwd>
<kwd lng="es"><![CDATA[atonía uterina]]></kwd>
<kwd lng="en"><![CDATA[Massive transfusion]]></kwd>
<kwd lng="en"><![CDATA[Obstetric hemorrhage]]></kwd>
<kwd lng="en"><![CDATA[Intensive care]]></kwd>
<kwd lng="en"><![CDATA[Social security]]></kwd>
<kwd lng="en"><![CDATA[Erytrocyte]]></kwd>
<kwd lng="en"><![CDATA[Platelets]]></kwd>
<kwd lng="en"><![CDATA[Uterine atony]]></kwd>
</kwd-group>
</article-meta>
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