TESIS 21 FIN 2.docx

Embed Size (px)

Citation preview

  • 8/17/2019 TESIS 21 FIN 2.docx

    1/78

     

    UNIVERSIDAD NACIONAL DEL ALTIPLANO

      FACULTAD DE MEDICINA HUMANA

      ESCUELA PROFESIONAL DE MEDICINA HUMANA

     

  • 8/17/2019 TESIS 21 FIN 2.docx

    2/78

    “FACTORES DE RIESGO E INCIDENCIA DE HEMORRAGIA POSTPARTO PRECOZEN MUJERES ATENDIDAS EN EL HOSPITAL CARLOS MONGE MEDRANO DURANTE

    EL PERIODO 01 DE AGOSTO – 01 DE NOVIEMBRE 2015”

      TESIS

     

    PRESENTADO POR LA BACHILLER:

      MARIA ESTHER DIANDERAS QUISPE

     

    PARA OPTAR EL TITULO PROFESIONAL DE:

      MEDICO CIRUJANO

      PUNO –PERU

    2016

  • 8/17/2019 TESIS 21 FIN 2.docx

    3/78

    DEDICATORIA

     A ! "#$%!&' (!)' A*+$,!*' J'*$ -.% /$% ,. / $,,. 3!$%*. "#$ ($ 4.*.4!&. $*

    ! !&'

  • 8/17/2019 TESIS 21 FIN 2.docx

    4/78

     AGRADECIMIENTOS

     A+%'&$74. ' D!./ -.% &'%$ 8.%3',$7' -'%' 4.*3!*#'% 4.* ! 4'!*.9 ' ! 8'!,!'

    $/-$4!',$*3$ ' !/ '$/3%./ &$ ,' #*!$%/!&'&

  • 8/17/2019 TESIS 21 FIN 2.docx

    5/78

      INDIC

    DEDICATORIA

     AGRADECIMIENTOS

    RESUMEN5

    SUMMAR;

    OBJETIVOS<

    PLANTEAMIENTO DEL PROBLEMA=

    JUSTIFICACION>>>>>>>>>>>>>>>>>>>>>>>>>>>>11

    HIPOTESIS12

    INTRODUCCION1?

    CAPITULO I ANTECEDENTES MARCO TEORICO16

    CAPITULO II METODOLOGIA APLICADA5=

    CAPITULO III ANALISIS E INTERPRETACION DE RESULTADOS6;

     ANE@O

    BIBLIOGRAFIA

  • 8/17/2019 TESIS 21 FIN 2.docx

    6/78

    RESUMEN

    L' ($.%%'+!' -./3-'%3. $/ ,' -%&!&' /'*+#*$' '.% &$ 500 44 &$/-#/ &$ #*

    -'%3. '+!*', '.% &$ 1000 44 &$/-#/ &$ #*' .-$%'4!* 4$/%$' L' 4'&' $*

    / &$ 10 $* ,./ *!$,$/ &$ ($'3.4%!3. . 29= +% $* ,' ($.+,.!*' L'

    4'#/' / 4.* &$ .%3',!&'& '3$%*' $* 3.&. $, #*&. L' !3'& &$ ,'/ HPP

    /.* -%$4.4$/ ,'/ "#$ .4#%%$* $* ,'/ -%!$%'/ 2 ( -./-'%3. /.* ,'/ /

    '+#&'/ +%'$/ L' $3!.,.+' $* /# '.%' -.% '3.*' #3$%!*' ,$ /!+#$ %$3$*4!*

    &$ -,'4$*3' &$/+'%%./ &$ 4%! '+!*'9 $/ ',3'$*3$ -%$$*!,$ 4.* $, '*$).

    '43!. &$, ',#%'!$*3.

    O)$3!./: I&$*3!8!4'% 8'43.%$/ &$ %!$/+. &$3$%!*'% ,' !*4!&$*4!' &$ ,'

    ($.%%'+!' -./3-'%3. -%$4.7 "#$ /$ -%$/$*3' $* $, (./-!3', C'%,./ M.*+$

    M$&%'*. $* $, -$%!.&. 01 &$ '+./3. ' 01 &$ *. 2015M3.&. &$ $/3#&!. &$ 3!-. -%./-$43!. ,.*+!3#&!*', &$/4%!-3!.9 *. $-$%!$*3', E,

    #*!$%/. ,. 4.*/3!3#$* 61< #)$%$/ +$/3'*3$/ -#%-$%'/ !*$&!'3'/ L' #$/3%'

    ,' 4.*8.%'* ?= -'4!$*3$/

    R$/#,3'&./: L' -%.'!,!&'& 4.* ,' "#$ '-'%$4$ ,' ($.%%'+!' -./3-'%3. -%$4.7 $*

    $, -$%!.&. 01 &$ '+./3. K01 &$ *. 2015 PI: ?=61< 69?1 9,' 3'/' &$ !*4!&$*4!'

    TI:?=61< 025 '. 0252 4'/./ '.9 $/ &$4!% 25 #)$%$/ -.% 100 '.

    C.*4,#/!.*$/ :,./ 8'43.%$/ /.4!.$4.*!4./ $* .%&$* &$ 8%$4#$*4!' $/3' ,'

    '*$!' 9+$/3'*3$ './' 9*!$, /.4!.$4.*!4. '). 9-%.4$&$*4!' %#%', E* ,'

    +$/3'4!* 8#$%.* ')' '/!/3$*4!' ', 4.*3%., -%$*'3',9 #,3!-'%!&'&9 -'%3. -%$3%!*.9

    5

  • 8/17/2019 TESIS 21 FIN 2.docx

    7/78

    '*3$4$&$*3$ &$ ,$+%'&. #3$%!*. ,./ 8'43.%$/ !*3%'-'%3. /.* '*$). $/-.*3'*$.

    &$, ',#%'!$*3.9 -'%3. *. !*/3!3#4!.*',

    P','%'/ 4,'$: ($.%%'+!' -./3-'%3. -%$4.79 8'43.% &$ %!$/+.9 !*4!&$*4!'

    SUMMARY

    PPH !/ ,..& ,.// +%$'3$% 3('* 500 44 '83$% '+!*', &$,!$% '*& !*4%$'/$& 100044

    '83$% ' C'$/'%$'* /$43!.* T($ &%.- !* .%$ 3('* 10 !* ($'3.4%!3 ,$$,/ '*& .% 

    2= + ($.+,.!* T($ ./3 4..* 4'#/$ .8 '3$%*', .%3',!3 .%,&!&$ (',8 3($ HPP '%$ $'%, 3(./$ .44#%%!*+ !* 3($ 8!%/3 2 ( -./3-'%3# '*& '%$ 3($

    $3!.,.+ +%'$/L' '4#3$ '*& ./3, 8.,,.$& #3$%!*$ '3.*!' %$3$*3!.* -,'4$*3'

    6

  • 8/17/2019 TESIS 21 FIN 2.docx

    8/78

  • 8/17/2019 TESIS 21 FIN 2.docx

    9/78

    KI&$*3!8!4'% ,./ 8'43.%$/ &$ %!$/+. &$ ,' ($.%%'+!' -./3-'%3. -%$4.7 $* -'4!$*3$/

    '3$*&!&'/ $* $, (./-!3', C'%,./ M.*+$ M$&%'*.KD$3$%!*'% ,' !*4!&$*4!' &$ ,' ($.%%'+!' -./3-'%3. -%$4.7 "#$ /$ -%$/$*3' $* $,

    (./-!3', C'%,./ M.*+$ M$&%'*.B –O)$3!./ $/-$48!4./:

    K!&$*3!8!4'% ,'/ 4'%'43$%/3!4'/ +$*$%',$/ &$ ,' #$/3%' $* $/3#&!.KD$3$%!*'% $, +%#-. $3'%!. / '8$43'&.K!&$*3!8!4'% ,./ 8'43.%$/ &$ %!$/+. -%$&.!*'*3$/ &$ ($.%%'+!' -./3-'%3. -%$4.7

    $* ,' #$/3%' &$ $/3#&!.

    PLANTEAMIENTO DEL PROBLEMA

    L' ($.%%'+!' -./3-'%3. $/ ,' -%!$%' 4'#/' &$ .%3',!&'& '3$%*' $* $, P$% E*

    2010 ,' %'7* &$ .%3',!&'& '3$%*' -'%' P$% $/ &$ 6; 1009000 *'4!&./ !./9

    '* 3$*$./ %$+!.*$/ 4.* ',3'/ 4!8%'/ &$ .%3',!&'& '3$%*' 3',$/ 4..: L!'9

    C')''%4'9 L' L!$%3'&9 P#*.9 P!#%'9 L''$"#$9 A*4'/(9 A%$"#!-'9 C',,'.9

     A-#%'49 L' L!$%3'&9 L.%$3. E* $, 2012 ,'/ 4'#/'/ &$ #$%3$ &!%$43'/9

    %$+!/3%'&'/ -.% $, M!*!/3$%!. &$ S',#& 8#$%.*: H$.%%'+!'/ 029 H!-$%3$*/!*

  • 8/17/2019 TESIS 21 FIN 2.docx

    10/78

    I*!&' -.% $, E'%'7. ?29 A.%3. 1;59 $ I*8$44!.*$/ %'*3$ $, P$%.&.

    &$ P#$%-$%!. 1S$ (' !*4%$$*3'&. $, -'%3. !*/3!3#4!.*', ' *!$, *'4!.*', &$ ;6 $* $, '. 200 '

  • 8/17/2019 TESIS 21 FIN 2.docx

    11/78

    P.% .3%. ,'&. $, *$%. &$ #$%3$/ '3$%*'/ *.3!8!4'&'/ $* ,./ './ 200

  • 8/17/2019 TESIS 21 FIN 2.docx

    12/78

    HIPOTESIS

    L./ 8'43.%$/ &$ %!$/+. -'%' ($.%%'+!' -./3-'%3. -%$4.7 $* *#$/3%' %$+!* /.* $,

    *!$, /.4!.$4.*!4. ').9 +%'&. &$ !*/3%#44!* !*4.-,$3' 9'*$!'

    9#,3!-'%!&'& 9,' 8',3' &$ '/!/3$*4!' ', 4.*3%., -%$*'3', 9 $, -'%3. &.!4!,!'%!.9

    -%$$4,'-/!' /$$%' 9&$/-%$*&!!$*3. -%$'3#%. &$ -,'4$*3' *.%.!*/$%3' 9

    -,'4$*3' -%$!' 3.3', 9-'%3. -%$3$%!*. 4.%!.'*!.*!3!/

    11

  • 8/17/2019 TESIS 21 FIN 2.docx

    13/78

      INTRODUCCION

    L' ($.%%'+!' -./3-'%3. &$8!*!&' 4.. #*' -%&!&' /'*+#*$' '.% &$ 500 44

    &$/-#/ &$ #* -'%3. '+!*', '.% &$ 1000 44 &$/-#/ &$ #*' .-$%'4!*

    4$/%$' S!* $'%+. $, 4,4#,. 4$%3$%. &$ $/3./ .,$*$/ $/ &!84!, 3!$*&$* '

    /#$/3!'% ,' -%&!&' ($3!4' ('/3' $* #* 50P.% $,,. /$ 4.*/!&$%' ', /'*+%'&.

    -./-'%3. 4.* 4'!./ ($.&!*!4./ "#$ %$"#!$%$ 3%'*/8#/!* &$ /'*+%$S$

    4,'/!8!4' $* ' ($.%%'+!' ./33%!4' /$$%':-$%&!&' '.% &$ 150044 3%'/ -'%3.

    '+!*',9 &!/!*#4!* -$%!-'%3. $* ,' ($.+,.!*' &$ +&, . 3%'*/8#/!* '+#&'

    #*!&'&$/ &$ /'*+%$9($.%%'+!' -./-'%3. -%!'%!' . -%$4.7: /! .4#%%$ $* ,'/

    -%!$%'/ 2 (.%'/ -./3-'%3. 94($.%%'+!' -./-'%3. /$4#*&'%!' . 3'%&!'  :/! .4#%%$

    $*3%$ ,'/ 2 (.%'/ 9('/3' ,' 4#,!*'4!* &$, -#$%-$%!.6 /$'*'/L' ($.%%'+!' -./3-'%3. HPP /!+#$ /!$*&. ,' / 4.* 4'#/' &$ .%3',!&'&

    '3$%*' 3.&. $, #*&.L' !3'& &$ ,'/ HPP /.* -%$4.4$/ ,'/ "#$ .4#%%$* $* ,'/

    -%!$%'/ 2 ( -./-'%3. +$*$%',$*3$9 ,'/ / '+#&'/ +%'$/ E* *#$/3%.

    12

  • 8/17/2019 TESIS 21 FIN 2.docx

    14/78

    -'!/ 9 ,' '.%' &$ +$/3'*3$/ *. %$4!$ '3$*4!* $&!4' ('/3' $, .$*3. &$,

    -'%3.9 '/ &$ ,' !3'& &$ 3.&./ ,./ -'%3./ $* %$'/ %#%',$/ 9$* $, (.+'% '*3$ ,'/

    4.-,!4'4!.*$/ %$4!* '4#&$* ' #* $/3',$4!!$*3. &$ /',#& $/3. 4.!*'&. 4.*

    $3%$' -.%$7' '*',8'$3!/. &' ,'/ -$.%$/ 3'/'/ &$ .%3',!&'& '3$%*' L'

    -%!*4!-', 4'3$+.%' &$ 4'#/'/ &$ #$%3$/ -'%' P#*. 4.%%$/-.*&$ ' ,'/

    ($.%%'+!'/ ./33%!4'/ 5?6L' ',3' !*4!&$*4!' &$ '*$!'9 $*3%$ ,'/ #)$%$/ &$ ,./ -'/$/ $* &$/'%%.,,.

    4.*3%!#$ ' #*' '.% .%3',!&'& '3$%*'9 &$!&. ' "#$ ,' #)$% 4.* '*$!'

    -#$&$ 3.,$%'% $*./ ,' (!-.!' "#$ 4.*,,$' ,' ($.%%'+!'

    L./ 8'43.%$/ &$ %!$/+. $* $, '*3$-'%3. :-%$$4,'-/!'9*#,!-'%!&'& 9+%'* &!/3$*4!*

    #3$%!*'8$3. '4%./.!4. 9$'%'7. #,3!-,$9 -.,!(!&%'*!./9 +%'* !.'3./!/

    #3$%!*' '*3$4$&$*3$ &$ 4$/'%$' '*3$%!.% 9'*3$4$&$*3$ &$ ($.%%'+!' -./3-'%3.

    -%$!' E* $, !*3%'-'%3.:T%''). &$ -'%3. -%.,.*+'&. /#-$%!.% ' 15K1< ( -$%!.&.

    $-#,/!. -%.,.*+'&.9$-!/!.3.!' $&!. ,'3$%', &$/4$*/. &$ -%$/$*3'4!*

    -%.,.*+'&.9&$/+'%%./ ,'4$%'4!.*$/ 4$%!4',$/ 9'+!*',$/ 9-$%!*$',$/

    E* ,' $3!.,.+' &$ ($.%%'+!' -./3-'%3. /$ &' -.% '%!./ $4'*!/./: '

    3%'*/3.%*./ &$, ',#%'!$*3. '3.*' #3$%!*': 8',,' -'%4!', . 3.3', $* ,' %$3%'44!*

    *.%', #3$%!*' C.3!,$&* %$3$*!&.: ,' -,'4$*3' (' /',!&.9 -$%. $* 8.%' -'%4!',

    R$3$*4!* -,'4$*3'%!'T%'#3!4'/ . &$/+'%%./: ' *!$, 4$%!4', . ' *!$,

    '+!*', 4T%'*/3.%*./ /!/3!4./ :&$8$43./ &$ ,' 4.'+#,'4!*L' /.%$ &!/3$*/!* &$, 3$%. $/ %!$/+. -'%' '3.*' #3$%!*' "#$ -#$&$ /$% &$!&'

    ' ,' -%$/$*4!' &$ '4%./.!' 8$3',9 -.,!(!&%'*!./ . '*.%',!&'& 8$3',Q -$%.9

    3'!* -#$&$ /$% -.% #*' $/3%#43#%' #3$%!*' '*.%', . 8',,' $* $, ',#%'!$*3.9

    4.* /'*+%'&. -./3$%!.%

    1?

  • 8/17/2019 TESIS 21 FIN 2.docx

    15/78

    L' 4.*3%'44!* -.%$ &$, !.$3%!. -#$&$ %$/#,3'% &$ 8'3!+'9 &$!&. ' 3%''). &$

    -'%3. -%.,.*+'&.9 $/-$4!',$*3$ /! (' $/3!#,'4!* !*,!* . 4.*,!*

    E* ',+#*./ 4'/./9 3'!* -#$&$ /$% -.% !*(!!4!* &$ ,'/ 4.*3%'44!.*$/ -.% #/.

    &$ &%.+'/9 4.. '+$*3$/ (',.+$*'&./ &$ '*$/3$/!'9 AINES9 /#,8'3. &$ '+*$/!.9

    /!-3!4. !3!4./ $3' *!8$&!-!*.L' %$3$*4!* &$ 3$)!&. -,'4$*3'%!. $%'*'/ &$ ,' -,'4$*3' $/ ,' 4'#/' &$ 5 '

    10 &$ ,'/ ($.%%'+!'/ -./-'%3. E, $4'*!/. *.%', &$, ',#%'!$*3.

    !*4,#$ $, &$/'%%.,,. &$ #* -,'*. &$ 4,!')$ $* ,' &$4!' '/', -.% &$'). &$ ,'

    -,'4$*3' E/3$ $4'*!/. -#$&$ $/3'% ',3$%'&. 4.-,!4'% ,' /',!&' &$ ,'

    -,'4$*3' E* $/3./ 4'/./9 /$ %$"#!$%$ %$',!7'% ,' $3%'44!* '*#',9 -%.4$&!!$*3.

    "#$ /$ $8$43#'% /! -./3$%!.% ' #* 3!$-. %'7.*',$ 10 ' ?0 !*#3./9 $,

    ',#%'!$*3. *. /$ (' -%.!&.E, '*$). '43!. &$, ',#%'!$*3. *./ -$%!3$ -%$$*!% ,' ($.%%'+!'

    -./3-'%3. 9,' 4.!*'4!* &$ ,' '&!*!/3%'4!* &$ #3$%.3*!4./ .!3.4!*'

    !*$&!'3'$*3$ &$/-#/ &$, *'4!!$*3. &$, 8$3.9 -!*7'!$*3. 4.%3$ 3$-%'*. &$,

    4.%&* #!,!4', 3%'44!* &$, 4.%&* 4.*3!*#' /#'$L' 3'"#!4'%&!' "#$ -#$&$ /$% $, *!4. /!+*. ,' '/.4.*/3%!44!* 4.-$*/'3.%!'

    '*3!$*$* ,' 3$*/!* '%3$%!', L' (!-.3$*/!* -#$&$ -%$/$*3'%/$

    3'%&!'$*3$94#'*&. ' /$ (' -$%&!&. $*3%$ $, ?0 $, 50 &$ ,' .,$!' E,

    .)$3!. $/ %$-.*$% $, .,#$* 4!%4#,'*3$ -'%' #*' '&$4#'&' -$%8#/!* 3!/#,'% /$

    -#$&$ #/'% $&!4'4!* #3$%.%$3%'43.%' 9$, '/')$ #3$%!*. 934*!4'/ &$ 4.*3%., ,.4',

    &$, /'*+%'&. 94!%#+'9 4.. #,3!' $&!&' ,' (!/3$%$43.'L'/ 4.*/$4#$*4!'/ &$ ,' HPP /.* $, 4(."#$9 *$4$/!&'& &$ 3%'*/8#/!.*$/ /#/

    %!$/+./9 !*8$44!.*$/ 4.*4.!3'*3$/9 '*$!' 9&!8!4#,3'& $* ,' ,'43'*4!' 94..

    /$4#$,'/ -'*(!-.-!3#!3'%!/. . /*&%.$ &$ S($$('* -%.,$'/ &$ 8$%3!,!&'&

    1

  • 8/17/2019 TESIS 21 FIN 2.docx

    16/78

    CAPITULO I ANTECEDENTES Y MARCO TEORICO

    1KANTECEDENTES

    S$ %$',!7 #* $*/'. 4,*!4. ',$'3.%!7'&. -.% 4.*+,.$%'&./9 #,3!4*3%!4.9 $*

     A%+$*3!*' U%#+#' 200?K2005 -'%' !&$*3!8!4'% 8'43.%$/ &$ %!$/+. &$ ($.%%'+!'

    -./3-'%3. $* -'4!$*3$/ 4.* -'%3. '+!*', $* #*' -.,'4!* &$ A%!4' L'3!*' E,

    .)$3!. -%!*4!-', &$ $/3$ $/3#&!. 8#$ !*4%$$*3'% $, #/. &$ &./ -%43!4'/

    ./33%!4'/ '/'&'/ $* ,' $!&$*4!': $, #/. &$ .!3.4!*' -'%' $, '*$). &$,

    ',#%'!$*3. ,' $-!/!.3.' /$,$43!'9 /$ $*4.*3% "#$ ,./ 8'43.%$/ &$ %!$/+.

    / 8#$%3$$*3$ '/.4!'&./ ' ,' HPP $* #)$%$/ 8#$%.*: -,'4$*3' %$3$*!&'

    ??9?9 $'%'7. ,3!-,$ 209=9 '4%./.' 1

  • 8/17/2019 TESIS 21 FIN 2.docx

    17/78

    L!'9 C')''%4'9 L' L!$%3'&9 P#*.9 P!#%'9 L''$"#$9 A*4'/(9 A%$"#!-'9

    C',,'.9 A-#%'49 L' L!$%3'&9 L.%$3.

    S$+* $, !*8.%$ $!3!&. -.% ,' D!%$44!* &$ E-!&$!.,.+' &$ ,' D!%$/' P#*.9 L'

    R$& &$ S',#& &$ S'* R.* 4.*3!*' 4.* / #$%3$/ '3$%*'/ T!$*$ $* /#

    ,!/3' ' 4!*4.9 /$+#!&. &$ H#'*4'* 4.* 3%$/9 A7*+'%. P#*. 4.* &./ 4.* #*.

    $/3* C'%'''9 C(#4#!3.9 E, C.,,'.9 L'-' S'*&!'D$ '4#$%&. ', 3!-. &$ #$%3$9 /$ ('* *.3!8!4'&. 1; 4'/./ &$ #$%3$ '3$%*' $*

    2015 3!-!8!4'&./ 4.. &!%$43'/9 $/ &$4!% .4#%%!&'/ -.% 4'#/'/ +!*$4.K./33%!4'/

    ,'/ !/'/ "#$ /$ %$+!/3%'%.* $* ,'/ R$&$/ &$ S',#& P#*. 29 A7*+'%. 29

    C'%''' 19 C(#4#!3. 19 E, C.,,'. 19 H#'*4'* 1 S'* R.* ?

     A/!!/. /$ ('* *.3!8!4'&. 6 4'/./ &$ #$%3$ '3$%*' !*&!%$43'/9 2 ,'/ "#$

    4.%%$/-.*&$* ' ,' R$& &$ S',#& S'* R.'*9 2 ' H#'*4'*9 1 ' S'*&!' 1 '

    L'-'9 $* 3.3', /#'* 1; &$4$/./C.* %$,'4!* ', !/. -$%.&. &$, '. 2019 ,' 4!8%' &$ #$%3$/ '3$%*'/ /$

    !*4%$$*3 $* &./9 -#$/ /.,. /$ %$-.%3'' #* 3.3', &$ 159 4.* ,./ /!+#!$*3$/

    &$3',,$/: P#*. $*4'$7'' 4.* 5 #$%3$/ /$+#!&. &$ S'* R.* 4.* 9 C(#4#!3.

    H#'*4'* 8!+#%''* 4.* &./ #$%3$/9 !$*3%'/ "#$ M$,+'% #*+#.

    4.-,$3''* ,' ,!/3' 4.* #*' 8',,$4!&' 4'&' #*. A *!$, *'4!.*', ,' .%3',!&'& '3$%*' -'/ &$ 5; &$8#*4!.*$/ $* $, '. 2010 '

    11 $* $, 2019 /$+* 4!8%'/ &$ ,' D!%$44!* &$ E-!&$!.,.+' &$, M!*!/3$%!. &$

    S',#& M!*/'9 ,. "#$ %$-%$/$*3' #* &$/4$*/. &$ 10 $* $/3$ *&!4$

     L' '3$*4!* -%$*'3', /$ !*4%$$*3 $*3%$ ,./ './ 200= 201 &$ =9? '

    =69=9 %$/-$43!'$*3$9 ./3%'*&. #* !*4%$$*3. !-.%3'*3$ $* ,' 7.*' %#%', &$

  • 8/17/2019 TESIS 21 FIN 2.docx

    18/78

    D$ '4#$%&. 4.* $/' !/' $*4#$/3'9 $, -'%3. !*/3!3#4!.*', 3'!* /$ !*4%$$*3

    &$

  • 8/17/2019 TESIS 21 FIN 2.docx

    19/78

    #)$%$/ /$ '8$43'* 4.* -$"#$'/ ($3!4'/ -%&!&'/9 4.. $/ $, 4'/. &$ ,'/ "#$

    -%$/$*3'* (!-$%3$*/!* -%.3$!*#%!'9 '*$!'9 &$/(!&%'3'4!* . /.* &$ ')'

    $/3'3#%' 1

    T'!* /$ '4$-3' 4.. &$8!*!4!*

    K L' 4'&' $* / &$ 10 $* ,./ *!$,$/ &$ ($'3.4%!3. . 29= +% $* ,'

    ($.+,.!*'KL' -%&!&' &$ /'*+%$ '.% ', 1 &$, -$/. 4.%-.%',P.% $/3. /$ (' /#+$%!&. 4.*/!&$%'% ($.%%'+!' -./3-'%3. ', /'*+%'&. $4$/!.

    "#$ ('4$ ' ,' -'4!$*3$ /!*3.3!4' + '%$.9 /*4.-$ . "#$ %$/#,3' $* /!+*./

    &$ (!-..,$!' + 3'"#!4'%&!'9 (!-.3$*/!*9 .,!+#%!' $/ &$4!% /'*+%'&. -./3-'%3.

    4.* 4'!./ ($.&!*!4./ "#$ %$"#!$%$ 3%'*/8#/!* &$ /'*+%$

    22KEPIDEMIOLOGIA

    L' ($.%%'+!' -./3-'%3. HPP /!+#$ /!$*&. ,' / 4.* 4'#/' &$ .%3',!&'&

    '3$%*' 3.&. $, #*&. 1 E/ %$/-.*/',$ ',%$&$&.% &$, ?0 &$ ,'/ #$%3$/

    '3$%*'/9 ,. "#$ $"#!',$ '

  • 8/17/2019 TESIS 21 FIN 2.docx

    20/78

    E* $, P$%9 ,' ($.%%'+!' -./3-'%3. /$ -%$/$*3' ('/3' $* $, 10 &$ ,./ -'%3./9

    $/ ,' -%!$%' 4'#/' 0 &$ #$%3$ '3$%*' #$%3$ &$ #*' #)$% %'*3$ /#

    $'%'7.9 -'%3. . -#$%-$%!.L' ($.%%'+!' -./3-'%3. -%!'%!' /$ -%$/$*3' $* $,

    K6 &$ ,./ -'%3./ L' ($.%%'+!' -./3-'%3. /$4#*&'%!' /$ -%$/$*3' $, 1K? &$

    ,./ -'%3./E* 2010 ,' %'7* &$ .%3',!&'& '3$%*' -'%' P$% $/ &$ 6; 1009000 *'4!&./

    !./9 '* 3$*$./ %$+!.*$/ 4.* ',3'/ 4!8%'/ &$ .%3',!&'& '3$%*' 3',$/ 4..:

    L!'9 C')''%4'9 L' L!$%3'&9 P#*.9 P!#%'9 L''$"#$9 A*4'/(9 A%$"#!-'9

    C',,'.9 A-#%'49 L' L!$%3'&9 L.%$3.E* $, 2012 ,'/ 4'#/'/ &$ #$%3$ &!%$43'/9 %$+!/3%'&'/ -.% $, M!*!/3$%!. &$ S',#&

    8#$%.*: H$.%%'+!'/ 029 H!-$%3$*/!* I*!&' -.% $, E'%'7. ?29

     A.%3. 1;5 $ I*8$44!.*$/ %'*3$ $, P$%.&. &$ P#$%-$%!. 1S$+* ,'/ $/3'&/3!4'/ 9$, *$%. &$ #$%3$/ '3$%*'/ 4'#/'/ ./33%!4'/ $*

    .%&$* &$ 8%$4#$*4!' -.% &$-'%3'$*3. &$ -%.4$&$*4!' $* 201? 8#$ :L.%$3. 9P!#%'9

    P#*. L!' D$*3%. &$ ,' DIRESA PUNO 201?9,' .%3',!&'& '3$%*' -.% 

    ($.%%'+!' -./3-'%3. 8#$ $* ,' %$& &$ /',#& &$ -%.4$&$*4!' : S'*&!' 9S'*

    R.*6E* P#*. ,./ %$/#,3'&./ &$ ,'/ #$%3$/ '3$%*'/ *.3!8!4'&'/ $* ,./ './ 200

  • 8/17/2019 TESIS 21 FIN 2.docx

    21/78

    $* $, -$%!.&. 200;K2011 E* $, -$%!.&. 2002K20119 &$, 3.3', &$ #$%3$/9 $, ?15

    .4#%%!$%.* $* $, $'%'7.9 1;1 $* $, -'%3. 51 $* $, -#$%-$%!.

    E, ,#+'% / 8%$4#$*3$ &$ .4#%%$*4!' &$ ,' #$%3$ '3$%*' 4.%%$/-.*&$ ' ,./

    $/3',$4!!$*3./ &$ /',#&9 -%!*4!-',$*3$ $* $, (./-!3', . 4,*!4'9 "#$ '4##,'* $,

  • 8/17/2019 TESIS 21 FIN 2.docx

    22/78

    S$+* ,'/ 4!8%'/ &$ %'7* $/3'*&'%!7'&' &$ -.%$7' $* 200= &$ P#*. 8#$ 609<

    -.%$7' $3%$' &$ 209;K?296 L' -%.!*4!' 4.* '.% !*4!&$*4!' &$ -.%$7' 8#$

    M.(. 4.*

  • 8/17/2019 TESIS 21 FIN 2.docx

    23/78

    L' A3$*4!* -%$*'3', /$ (' !*4%$$*3'&. $*3%$ $, '. 2000 2012 &$

  • 8/17/2019 TESIS 21 FIN 2.docx

    24/78

    2?KCLASIFICACION

    ?1KH$.%%'+!' -./3-'%3. -%!'%!' . -%$4.7: $/ ,' -%&!&' /'*+#*$' "#$ .4#%%$

    $* ,'/ -%!$%'/ 2 (.%'/ -./3-'%3.

    ?2KH$.%%'+!' -./3-'%3. /$4#*&'%!' . 3'%&' : $/ ,' -$%&!&' /'*+#*$' "#$ .4#%%$

    $*3%$ ,'/ 2 (.%'/ 9('/3' ,' 4#,!*'4!* &$, -#$%-$%!. 6 /$'*'/ . 2 &'/??KH$.%%'+!' ./33%!4' '/!' . /$$%': $/ ,' -$%&!&' /'*+#*$' '.% &$

    150044 3%'/ $, -'%3. '+!*',9 3'!* 4#'*&. ,' &!/!*#4!* &$ ($.+,.!*' $* $,

    -$%!-'%3. $/ '.% &$ +&, . 4#'*&. /$ %$"#!$%$ ,' 3%'*/8#/!* '+#&' &$ / &$

    #*!&'&$/ &$ /'*+%$

    2KFACTORES DE RIESGO PARA HEMORRAGIA POSTPARTO

    L./ 8'43.%$/ &$ %!$/+. &$ HPP ('* /!&. $/3#&!'&./ -'%' !&$*3!8!4'% ' ,'/ #)$%$/

    $'%'7'&'/ 4.* %!$/+. '#$*3'&. L./ ,!%./ &$ 3$3. &$ ./3$3%!4!' $*#$%'*&!$%/./ -%$&!/-.*$*3$/9 /!* !*&!4'% /# !-.%3'*4!' . 8%$4#$*4!' %$,'3!'E* 4'/. &$ ,' #,3!-'%!&'& 9 ', *. /$% ,' 4.*3%'44!* &$, 3$%. ,. "#$ -%$!$*$ ,'

    ($.%%'+!'9 /!*. ,' %$3%'44!* &$ ,' 8!%' !.$3%!', 9$/3' %$3%'44!* /$ $ '8$43'&'

    $* $, 3$%. &$ ,' +%'* #,3-'%' -.% ,' $&'&9 ,' 4!4'3%!7'4!* $, '+.3'!$*3.

    I+#',$*3$9 4'!./ $/4,$%3!4./ $* ,./ '/./ #3$%!*./ ,,$'* ' "#$ /3./ /$

    .4,#'* 4.* / &!8!4#,3'&9 ,. "#$ 8'4!,!3' $, /'*+%'&. 4.*3!*#. -#$&$ ,,$'% '#*' ($.%%'+!' -./3-'%3. 16L' /.%$ &!/3$*4!* #3$%!*' &$!&' ' '4%./.!' 8$3', 9 -.,!(!&%'*!./ .

    '*.%',!&'& 8$3', /.* 8'43.%$/ &$ %!$/+. -'%' '3.*' #3$%!*' /$4#*&'%!' &$!&. '

    "#$ $, 3.*. #/4#,'% #3$%!*. &!/!*#$ -.% $, 3!$-. -%.,.*+'&. &$ $-./!4!*

    2?

  • 8/17/2019 TESIS 21 FIN 2.docx

    25/78

    E* #4(./ $'%'7./ ,3!-,$/9 ,' +%'* %$' -,'4$*3'%!' $, 3$%.

    $4$/!'$*3$ &!/3$*&!&. -.*$* ' ,' '&%$ $* %!$/+. &$ ($.%%'+!' &$/-#/ &$,

    -'%3.

    E, 3%''). &$ -'%3. -%.,.*+'&. 4.*$ ' 8'3!+' #3$%!*' $/-$4!',$*3$ /! ('!*,!* . 4.*,!* 4.. 4.*/$4#$*4!' &$ ,' -.%$ 4.*3%'44!* &$,

    !.$3%!. /$ -%.!% ($.%%'+!'E* 4#'*3. ' ,' $-!/!.3.' ,' ,!3$%'3#%' .8%$4$ &'3./ /,!&./ /.%$ ,' %$,'4!* 4.*

    #*' /$$%' .%!,!&'& '3$%*' D'&. "#$ $* #4(./ 4'/./ ,' $-!/!.3.'

    '#$*3' /!+*!8!4'3!'$*3$ ,' -%&!&' &$ /'*+%$ '#$*3' ,' '-'%!4!* &$

    ($.%%'+!'/ -./3-'%3.9 /$ '/.4!' 4.* #*' '.% .4#%%$*4!' &$ ,'4$%'4!.*$/ &$

    3$%4$% 4#'%3. +%'&. 4'#/' #* '.% &.,.% "#$ ,./ &$/+'%%./ $/-.*3*$./L' -%$/$*4!' &$ -,'4$*3' -%$!' 3.3', $* $, 8!* &$ $'%'7. $/ 8'43.% &$ %!$/+.

    -'%' ($.%%'+!' -./3-'%3. -.% /# !*/$%4!* $* /$+$*3. #3$%!*.L./ /*&%.$/ (!-$%3$*/!./ &$, $'%'7. .3%'/ 4.-,!4'4!.*$/ "#$ -%.$*

    !*)#%!' &$, $*&.3$,!. '/4#,'% 4.. ,' &!'$3$/ $,,!3#/ . ,'/ $*8$%$&'& %$*',

    4%*!4' -#$&$* %.-$% ,./ '/./ &$ ,' &$4!' '/', -%.!% $3%''/'4!*

    /'*+#*$' $, 4.*/!+#!$*3$ ($'3.' %$3%.-,'4$*3'%!. "#$ #$/3%' $,

    &$/-%$*&!!$*3. -%$'3#%. &$ -,'4$*3'9 $/3$ ,3!. /! !*8!,3%' ,' -'%$& #3$%!*' -'/'

    ' ,' /$%./' &' #* 4.,.% '7#, .3$'&. $/ $, 3$%. &$ 4.#$,'!%$ . '-.-,$)' #3$%!*'

    -%$/$*3'*&. '3.*' #3$%!*' S.* 8'43.%$/ &$ %!$/+. $, &$/-%$*&!!$*3. -%$'3#%. &$ -,'4$*3' *.%.!*/$%3'9

    -%$$4,'-/!' +%'$9 $4,'-/!' 9$.,!/. &$ ,!"#!&. '*!3!4. /$-/!/9

    3%'*/8#/!.*$/ $* 8!* &.*&$ $!/3' 4.'+#,'4!* !*3%''/4#,'% &!/$!*'&' 1

  • 8/17/2019 TESIS 21 FIN 2.docx

    26/78

    &!/3%!#4!* $* ,'/ 4,#,'/ &$, /4#,. ,!/. S$ (' &$./3%'&. "#$ $, '+*$/!.

    '#$*3' $, 8,#). /'*+#*$. /$4#*&'%!. ' ,' '/.&!,'3'4!* &$ ,./ '/./ #3$%!*./

    P.% ,. 3'*3. $, /#,8'3. &$ '+*$/!. -%.,.*+' ,' %'4!* &$, -'%3.9 '#$*3'*&. $,

    *$%. &$ 4$/%$'/ ,' ($.%%'+!' -./3-'%3.L' ',3' !*4!&$*4!' &$ '*$!'9 $*3%$ ,'/ #)$%$/ &$ ,./ -'/$/ $* &$/'%%.,,.

    4.*3%!#$ ' #*' '.% .%3',!&'& '3$%*'9 &$!&. ' "#$ ,' #)$% 4.* '*$!'

    -#$&$ 3.,$%'% $*./ ,' (!-.!' "#$ 4.*,,$' ,' ($.%%'+!' S$+* ,' OMS 2011 /$

    4.*/!&$%' '*$!' $* #)$%$/ $'%'7'&'/ ' *!$, &$, '% /! $, ',.% &$ ,'

    ($.+,.!*' $/ $*.% &$ 11 +, '*$!' ,$$ 10K109= +, 9.&$%'&' ;K== +,

    /$$%' $*.% &$ ;+,S$ /'$ "#$ ' 4!$%3' ',3!3#& '#$*3'* ,'/ 4.*4$*3%'4!.*$/

    &$ ($.+,.!*' -.% ,. "#$ ,' '*$!' -.&%' !*8%'',.%'%/$9 /$ %$"#!$%$ %$',!7'% 

    ')#/3$ ' ,' ($.+,.!*' $*4!' &$ ,./ 1000 /* #* ')#/3$ &$ K092 +,9 ' ,./

    1500 /* ')#/3$ &$ K095 +,9 $* ,./ 2000 /* #* ')#/3$ &$ K09

  • 8/17/2019 TESIS 21 FIN 2.docx

    27/78

    KP%$/$*4!' &$ -%$$4,'-/!' / '#* /! $!/3!. '&!*!/3%'4!* &$ /#,8'3. &$

    '+*$/!.

    KG%'* &!/3$*4!* #3$%!*' 8$3. '4%./.!4. 9$'%'7. ,3!-,$9 -.,!(!&%'*!./9

    +%'* !.'3./!/ #3$%!*'

    KA*3$4$&$*3$ &$ 4$/%$' '*3$%!.%

    KA*3$4$&$*3$ &$ ($.%%'+!' -./3-'%3. -%$!'

    KA*3$4$&$*3$ &$ 3%'*/3.%*./ &$ 4.'+#,'4!*

    E* $, !*3%'-'%3.:

    KT%''). &$ -'%3. -%.,.*+'&. /#-$%!.% ' 15K1< (

    KP$%!.&. $-#,/!. -%.,.*+'&.

    KE-!/!.3.' $&!. ,'3$%',

    KD$/4$*/. &$ -%$/$*3'4!* -%.,.*+'&'

    KD$/+'%%./ ,'4$%'4!.*$/ 4$%!4',$/9 '+!*',$/9 -$%!*$',$/

    KP'%3. '/!/3!&. 4.* 8%4$-/ 2

    F'43.%$/ &$ %!$/+. /$+* ,' $3!.,.+':

    E* '3.*' #3$%!*' : A*3$4$&$*3$/: #,3!-'%!&'& 9 +$/3'*3$ './'C'%'43$%/3!4'/ :'4%./.!'9 -.,!(!&%'*!. 9$'%'7. #,3!-,$9&$/-%$*&!!$*3.

    -%$'3#%. &$ -,'4$*3' *.%.!*/$%3'9 -'%3. -%.,.*+'&. 9-'%3. -%$4!-!3'&.9

    4.%!.'*!.*!3!/9!.'3./!/ #3$%!*'9'*!.%' &$ %!/3$,,$%

    26

  • 8/17/2019 TESIS 21 FIN 2.docx

    28/78

    I*3$%$*4!.*$/:.!34!4./9'*$/3$/!' +$*$%',9/#,8'3. &$ '+*$/!.93.4.,!3!4./E* %$3$*4!* &$ -,'4$*3':

     A*3$4$&$*3$/: 4!4'3%!7 #3$%!*' -%$!' 9,$+%'&./ #3$%!*./C'%'43$%/3!4'/:!.'3./!/ #3$%!*'9 '4%$3!/. -,'4$*3'%!.9'*.','/ #3$%!*'/9

    4.%!.'*!.*!3!/9 -%$'3#%!&'&9 -,'4$*3' -%$!' 9-'%3. -%.,.*+'&.I*3$%$*4!.*$/ :',' 4.*,!* &$, -'%3.9 ', '*$). &$, ',#%'!$*3.E* %$3$*4!* &$ %$/3./ -,'4$*3'%!./:

     A*3$4$&$*3$/: 4!4'3%!7 #3$%!*' -%$!'9 '*3$4$&$*3$/ &$ ,$+%'&./ #3$%!*./C'%'43$%/3!4'/ : !.'3./!/ 9'4%$3!/. -,'4$*3'%!. 9,#,. -,'4$*3'%!.

    '$%%'*3$ 9!3. 8$3',9 4.%!.'*!.*!3!/ 9',#%'!$*3. '*#', !*4.-,$3.I*3$%$*4!.*$/:',' 4.*,!* &$, -'%3.9', '*$). &$, ',#%'!$*3.E* ,$/!* &$ 4'*', &$, -'%3.:

     A*3$4$&$*3$/: -%!!+$/3' 9 '4%./.!'C'%'43$%/3!4'/ :-'%3. -%$4!-!3'&. 9$-#,/!. -%.,.*+'&.9 -'%3. !*/3%#$*3'&.9

    $3%'44!* -.&,!4' 9-$%!* 4.%3. 8!%./. 9'%!4$/ #,.-$%!*$',$/ $-!/!.3.'9' ,'

    '43!3#& &$ -%$/$*3'4!* 9'*!.%' &$ %!/3$,,$%9 ',' '3$*4!* &$, $-#,/!.1

    25KPATOGENIA

    E, !.$3%!. $/ $, 4.-.*$*3$ #/4#,'% &$, 3$%. $/3 4.-#$/3. -.% 8!%'/

    #/4#,'%$/ &!/-#$/3'/ $* 3%$/ 4'-'/ L' 4'-' !*3$%$&!' 3!$*$ #*' 8.%' &$ .4(.

    $/ 8#*&'$*3', $* $, -%.4$/. &$ ($./3'/!' &$, ,$4(. -,'4$*3'%!.D#%'*3$ ,' %$3%'44!* *.%', #3$%!*'9 ,./ '/./ 4.#*!4'*3$/ $*3%$ ,' '&%$ ,'

    -,'4$*3' /.* .,!3$%'&./ -.% $/3'/ 8!%'/ #/4#,'%$/9 &!/!*#$*&. $* 8.%'

    $!&$*3$ ,' -%&!&' /'*+#*$'D#%'*3$ $, ',#%'!$*3.9 ,'/ 8!%'/ #/4#,'%$/ #3$%!*'/ /$ 4.*3%'$* /$ %$3%'$*Q

    $, !.$3%!. -%.+%$/!'$*3$ /$ $*+%./' $, .,#$* !*3%'#3$%!*. &!/!*#$L' -,'4$*3' *. 3!$*$ ,' -%.-!$&'& &$ 4.*3%'$%/$ 4.!$*7' ' /$-'%'%/$ ' $&!&'

    "#$ ,' /#-$%8!4!$ &$, 3$%. $/ $*.% C#'*&. ,' -,'4$*3' /$ ' /$-'%'*&. -.% $/3'

    !*4..%&!*'4!* &$ /#-$%8!4!$/9 $, 3$%. $/ +,.#,./. 4.*/!/3$*3$9 ,,$+'*&. ' ,'

    ',3#%' &$, .,!+. $ !*4,#/. ' $4$/ -#$&$ $/3'% &$'). &$ $/3$ -#*3. &$

    2;

  • 8/17/2019 TESIS 21 FIN 2.docx

    29/78

    %$8$%$*4!' E, 4.%&* #!,!4', -#$&$ -'%$4$% ','%+'&. E/3$ -%.4$/. ,,$'

    ('!3#',$*3$ 10 ' ?0 !*#3./ S! ,' -,'4$*3' *. /$ /$-'%' &$*3%. &$ ,./ ?0

    !*#3./ ,#$+. &$, *'4!!$*3.9 /$ 4.*/!&$%' #* ',#%'!$*3. -%.,.*+'&.

    /$+#%'$*3$ ' ' *$4$/!3'% #*' !*3$%$*4!* '&!4!.*',9 "#$ /$%' ,' $3%'44!*

    '*#', &$ ,' -,'4$*3'L' 4'*3!&'& &$ /'*+%$ "#$ ,,$+' ' ,' -,'4$*3' $* #* $'%'7. ' 3%!*.9

    %$-%$/$*3' $*3%$ 500 '

  • 8/17/2019 TESIS 21 FIN 2.docx

    30/78

    $*4'%4$,'&' $* $, 3$%.9 -.% ,. "#$ *. -#$&$ /$% $-#,/'&' ,' 4'!&'& #3$%!*'

    .4#-'&' *. ,.+%'% 4.*3%'$%/$ $8!4'7$*3$9 $, /'*+%'&. 4.*3!*'

    T%'#3!4'/ . &$/+'%%./: ' *!$, 4$%!4', . ' *!$, '+!*',

    4 T%'*/3.%*./ /!/3!4./:&$8$43./ &$ ,' 4.'+#,'4!*

    L' ($.%%'+!' -./3-'%3. -%!'%!' $/ 4'#/'&' -.% :8',,' &$ 4.*3%'44!* '&$4#'&'

    &$, 3$%. &$/-#/ &$, -'%3. HPP '3*!4' $* $, =0 &$ ,./ 4'/./ O3%'/

    $3!.,.+'/ 4.%%$/-.*&$* ' 3%'#' &$, 3%'43. +$*!3', "#$ $-,!4' $, ; 9 ,'

    %$3$*4!* &$ -,'4$*3' 8',,' &$, /!/3$' &$ 4.'+#,'4!* 9 ,./ 4#',$/ $-,!4'* $,

    %$/3'*3$ ? 1 AKETIOLOGIA DE HEMORRAGIA POSTPARTO PRIMARIAK'3.*!' #3$%!*'K-,'4$*3' %$3$*!&' 9$/-$4!',$*3$ -,'4$*3' '4%$3'K&$8$43./ $* ,' 4.'+#,'4!*K,$/!* &$, 4'*', &$, -'%3.K!*$%/!* #3$%!*'BKETIOLOGIA DE HEMORRAGIA POSTPARTO SECUNDARIAK/#!*.,#4!* &$, ,$4(. -,'4$*3'%!.K%$3$*4!* &$ %$/3./ -,'4$*3'%!./K$*&.$3%!3!/K3%'*/3.%*./ &$ ,' 4.'+#,'4!*

     ATONA UTERINAE/ %$/-.*/',$ &$ 50 &$ ,'/ ($.%%'+!'/ &$, ',#%'!$*3. &$ &$ ,'/

    #$%3$/ '3$%*'/ E/3' 4.-,!4'4!* /$ -%$/$*3' -./3$%!.% ' ,' /',!&' &$ ,'

    -,'4$*3'9 -.%"#$ $, 3$%. *. /$ 4.*3%'$ %$3%'44!*9 $!/3!$*&. -.% ,. 3'*3. #*'

    -%&!&' 4.*3!*#' &$ /'*+%$ &$/&$ $, ,#+'% &.*&$ $/3'' !-,'*3'&' ,' -,'4$*3'L'

    '3.*' #3$%!*' ,' 8',,' &$ ,' %$3%'44!* &$ ,'/ 8!%'/ &$, /4#,. #3$%!*. -#$&$*

    ,,$'% %-!&'$*3$ ' ($.%%'+!' /$$%' /(.4 (!-..,!4. E/3' 4.-,!4'4!*

    $/3 # %$,'4!.*'&' -.% ,' -%$/$*4!' &$ 4'#/'/ -%$&!/-.*$*3$/9 $*3%$ ,'/ 4#,$/

    -.&$./ 4!3'%:' P.% /.%$&!/3$*/!* #3$%!*': E'%'7. ,3!-,$

    2=

  • 8/17/2019 TESIS 21 FIN 2.docx

    31/78

    P.,!(!&%'*!./9 M'4%./.' 8$3', M#,3!-'%!&'& P.% 8'3!+' #3$%!*': M',' &!%$44!* &$, ',#%'!$*3.

    A*!.*!3!/ P'%3. -%.,.*+'&. A&!*!/3%'4!* *. 4.*3%.,'&' &$ .!34!4./4 P.% ./3%#44!* #3$%!*' R$3$*4!* &$ -'%3$/ 8$3',$/ P,'4$*3' '4%$3'L' /.%$&!/3$*/!* &$, 3$%. $/ #*' 4'#/' '/.,#3' . %$,'3!' &$ %!$/+. -'%'

    '3.*' #3$%!*' "#$ -#$&$ /$% &$!&' ' ,' -%$/$*4!' &$ '4%./.!' 8$3',9

    -.,!(!&%'*!./ . '*.%',!&'& 8$3',Q -$%.9 3'!* -#$&$ /$% -.% #*' $/3%#43#%'

    #3$%!*' '*.%', . 8',,' $* $, ',#%'!$*3.9 4.* /'*+%'&. -./3$%!.%L' 4.*3%'44!* -.%$ &$, !.$3%!. -#$&$ %$/#,3'% &$ 8'3!+'9 &$!&. ' 3%''). &$

    -'%3. -%.,.*+'&.9 $/-$4!',$*3$ /! (' $/3!#,'4!* !*,!* . 4.*,!*

    E* ',+#*./ 4'/./9 3'!* -#$&$ /$% -.% !*(!!4!* &$ ,'/ 4.*3%'44!.*$/ -.% #/.

    &$ &%.+'/9 4.. '+$*3$/ (',.+$*'&./ &$ '*$/3$/!'9 AINES9 /#,8'3. &$ '+*$/!.9

    /!-3!4. !3!4./ $3' *!8$&!-!*.O3%'/ 4'#/'/ !*4,#$* !-,'*3'4!* ')' &$ ,' -,'4$*3'9 3.!*'/ '43$%!'*'/

    4.%!.'*!.*!3!/9 $*&.$3%!3!/9 /$-3!4$!'9 (!-.!' &$!&' ' (!-.-$%8#/!* . 3$%.

    &$ C.#$,'!%$9 &$/-%$*&!!$*3. &$ -,'4$*3' *.%.!*/$%3' ,' !*$%/!* #3$%!*'

    "#$ ,,$' ' (!-.3$%!'9 &$!&' ' %$/#4!3'4!* '/!' . $3$%!.%!7'4!* #3$%!*'

    -%.,.*+'&'2

    RETENCIN DE RESTOS PLACENTARIOS

    ?0

  • 8/17/2019 TESIS 21 FIN 2.docx

    32/78

    L' %$3$*4!* &$ 3$)!&. -,'4$*3'%!. $%'*'/ &$ ,' -,'4$*3' $/ ,' 4'#/' &$ 5 '

    10 &$ ,'/ ($.%%'+!'/ -./3-'%3. L' 4.*3%'44!* ,' %$3%'44!* #3$%!*' $-!$7'*

    ,#$+. &$ ,' $-#,/!* &$ ,' -,'4$*3' /# 4.%%$43' $-#,/!* -$%!3$ #*'

    4.*3%'44!* .4,#/!* &$ ,./ '/./ /'*+#*$./ %$/-$43!./L' %$3$*4!* &$ #*' -.%4!* &$ ,' -,'4$*3' $/ / 4.* /! ,' -,'4$*3' /$

    &$/'%%.,,' 4.. /#44$*3#%!'&' . 4.* #* ,#,. '44$/.%!. N.%',$*3$9 &$/-#/

    &$ ,' $-#,/!* &$ ,' -,'4$*3' $/3' &$$ /$% $'!*'&'Q / '*9 /! ,#$+. &$ /#

    $-#,/!* $!/3$ /'*+%'&.9 ,' -,'4$*3' &$$%' .,!+'3.%!'$*3$ /$% 

    !*/-$44!.*'&'9 -'%' $!&$*4!'% ,' !*3$+%!&'& &$ ,./ '/./ /'*+#*$./ ,'

    !*3$+%!&'& &$ ,'/ $%'*'/E/3./ (',,'7+./ 4,*!4./ /#+!$%$* #*' %$3$*4!* -'%4!', . #* ,#,. '44$/.%!.

    D$$./ %$4.%&'% "#$ ,' %$3$*4!* &$ -,'4$*3' $/ / 8%$4#$*3$ $* +$/3'4!.*$/

    -%$3%!*. $3%$./ $*.% &$ 2 /$'*'/ -.% $,,. $/3 *.%'&' ,' %$!/!*

    &$ ,' 4'!&'& #3$%!*' $* $/3./ 4'/./RETENCIN PLACENTARIA:E, $4'*!/. *.%', &$, ',#%'!$*3. !*4,#$ $, &$/'%%.,,. &$ #* -,'*. &$

    4,!')$ $* ,' &$4!' '/', -.% &$'). &$ ,' -,'4$*3' E/3$ $4'*!/. -#$&$ $/3'% 

    ',3$%'&. 4.-,!4'% ,' /',!&' &$ ,' -,'4$*3'E* $/3./ 4'/./9 /$ %$"#!$%$ %$',!7'% ,'

    $3%'44!* '*#',9 -%.4$&!!$*3. "#$ /$ $8$43#'% /! -./3$%!.% ' #* 3!$-.

    %'7.*',$ 10 ' ?0 !*#3./9 $, ',#%'!$*3. *. /$ (' -%.!&. E/ )#/3'$*3$

    $* $/3$ -%.4$&!!$*3. "#$ $, -%.8$/!.*', "#$ '3!$*&$ $, -'%3. &$$ !+!,'% 

    '&$4#'&'$*3$ ,'/ &!8$%$*3$/ 8.%'/ &$ -,'4$*3' '&($%$*3$ '*.%', "#$ -#$&$

    $*4.*3%'%: '4%$3'9 !*4%$3' -$%4%$3' C'&' #*' &$ $/3'/ $*3!&'&$/ -#$&$ /$% 8.4',9

    -'%4!', . 3.3',S! $, -,'*. &$ 4,!')$ *. -#$&$ /$% ,.4',!7'&. -.% $, $'!*'&.% 4.* ,' '*.

    &$*3%. &$, 3$%.9 #* -.4. &$ $/8#$%7. -'%' %$.$% ,' -,'4$*3' &$$%' &$3$*$%,.

    ?1

  • 8/17/2019 TESIS 21 FIN 2.docx

    33/78

    &$$ /$% 8.%#,'&. #* -,'* &$ '*$). %-!&. U* &!'+*/3!4. 3$-%'*. #*

    '*$). -3!. /.* !-$%'3!./9 -.%"#$ ,'/ '*.%',!&'&$/ &$ -,'4$*3' '&($%$*3$

    $/3* '/.4!'&'/ 4.* #*' 3'/' &$ .%3',!&'& '3$%*' 4$%4'*' ', ;

     A,+#*./ $/3#&!./ !*&!4'* #*' !*4!&$*4!' &$ '4%$3!/. -,'4$*3'%!. $* 1 &$ 4'&'5?? $'%'7./ L' !*4!&$*4!' &$-$*&$ &$ ,./ 4%!3$%!./ &$ &!'+*/3!4. #3!,!7'&./:

    4,*!4./ 9%'&!.,+!4./ 4'%'43$%$/ (!/3.,+!4./L' !*4!&$*4!' 3'!* -'%$4$ !*4%$$*3'%/$ 4.* $, *$%. &$ 4$/%$'/ %$',!7'&'/

    '* / /! (' ,' 4.!*'4!* &$ -,'4$*3' -%$!' 4$/%$' -%$!' U*' '/$

    4.* -'%' $/3$ %!$/+. $/ ,' '*.%',!&'& &$, $*&.$3%!.F'43.%$/ &$ %!$/+. '/.4!'&./ ' -,'4$*3' '4%$3' E&'& $*.% ' ?0 './ P'%!&'& 2 ' ? C$/%$' -%$!': ?5 L$+%'&. -%$!.: 1< ' 60 R$.4!* '*#', -,'4$*3'%!' -%$!' R$3$*4!* -,'4$*3'%!' $* $'%'7./ -%$!./ I*8$44!.*$/L' -,'4$*3' 4%$3' $/ ,' 8.%' / 4.* &$ -,'4$*3' '&($%$*3$ '*.%', /$

    $*4#$*3%' $* '-%.!'&'$*3$

  • 8/17/2019 TESIS 21 FIN 2.docx

    34/78

    /'*+#*$'/ $* $/3$ 4'/. -#$&$* /$% 3'* ',3'/9 /#-$%!.%$/ ' 2 500 , 9 /! $/3

    '/.4!'&' ' -,'4$*3' -%$!'9 $, /'*+%'&. -#$&$ /$% '* #4(. '.%L' ($.%%'+!' &$ #*' -,'4$*3' 4%$3' -'%4!', $/ #/#',$*3$ / +%'$ "#$ $*

    #*' 4%$3' 8.4', . 3.3',9 4.. %$/#,3'&. &$ #*' -.%4!* &$ !.$3%!. "#$ $/3'&($%!&. ' &!4(./ 8%'+$*3./ E* #*' -%$/$*3'4!* '+#&'9 $, &!'+*/3!4. $/

    #/#',$*3$ 4,*!4. U*' -,'4$*3' '&($%$*3$ '*.%', 4.* . /!* ($.%%'+!' -#$&$

    ' $*#&. *$4$/!3'% #*' $3%'44!* '*#',9 %$/#,3'*&. $* 8%'+$*3'4!* ,$+%'&.

    4.-,$$*3'%!. E, $'$* &$ ,' -,'4$*3' &$/-#/ &$ #*' $3%'44!* *.%',

    -#$&$ %$$,'% -%&!&' &$ 4.3!,$&.*$/9 &$ '*$%' "#$ ,' %$$-,.%'4!* '*#', &$

    ,' 4'!&'& #3$%!*' &$$ /$% %$',!7'&' -'%' $%!8!4'% /! ,' %$.4!* &$ ,' -,'4$*3' $/

    4.-,$3'L' -,'4$*3' 4%$3' -#$&$ /$% &!84!, &$ &!'+*./3!4'% (!/3.,+!4'$*3$ ' 3%'/ &$

    4%!3$%!./ !4%./4-!4./9 $* '#/$*4!' &$ &$4!' '/', E* 4.*3%'/3$9 ,' !*4%$3'

    -$%4%$3' -#$&$* /$% &!'+*./3!4'&'/ (!/3.,+!4'$*3$9 -'%3!4#,'%$*3$ /! /$ %$',!7'

    #*' (!/3$%$43.' S!* $'%+.9 /! *. /$ /./-$4(' &$ #*' '&($%$*4!' '*.%',9 ,'

    #$/3%' &$ ,' (!/3$%$43.' -#$&$ -%$/$*3'% &!8!4#,3'&$/ $* ,' !*3$%-%$3'4!*L' !*3$%-%$3'4!* (!/3.,+!4' -#$&$ $/3'% ,!!3'&' -.% ,' ($.%%'+!' $3$*/'9

    4.*$*3$ !&$*3!8!4'&' $* $/-$4$*$/ -'3.,+!4./ S!* $'%+.9 ,' $',#'4!*

    (!/3.,+!4' 4#!&'&./'9 -'%3!4#,'%$*3$ $* ,' -$%!8$%!' &$ ,'/ %$'/ &$ ($.%%'+!'9

    ' $*#&. &$./3%'%* 3%.8.,'/3. $* $, !.$3%!. . /$%./'9 $* $, 4'/. &$

    -$%4%$3' A,+#*./ !*$/3!+'&.%$/ ('* &$/4%!3. #* &!'+*/3!4. -%$-'%3. &$ -,'4$*3' '4%$3'9

    #3!,!7'*&. 3.&./ %'&!.,+!4./ S$ (' ./$%'&. #*' 7.*' ,4!&' /#-,'4$*3'%!'

    *.%',$*3$ -%$/$*3'&' $* ,' -'%3$ '*3$%!.% ')' &$ ,' -,'4$*3'9 "#$ %$-%$/$*3'

    ,' &$4!'

    ??

  • 8/17/2019 TESIS 21 FIN 2.docx

    35/78

    T'!*9 /$ (' -%$/$*3'&. 4.#*!4'4!.*$/ $* ,' -,'4$*3' -$%4%$3' /.%$

    $/-$4!$*$/ -'3.,+!4./ 4.* $4.+%'8' '*3$/ &$ "#$ ,' 4!%#+' %$$,$ ,' '#/$*4!'

    3.3', . -'%4!', &$ $/3' 7.*' $4.,4!&' A/9 /$ (' /#+$%!&. "#$9 $* #*' -'4!$*3$

    4.* %!$/+. ',3. &$ '4%$3!/. -,'4$*3'%!.9 $4.+%8!4'$*3$ -#$&$ /$% 3!, !/#',!7'% 

    ,' !*3$%8'/$ 3$%. -,'4$*3'%!' E* $/3./ 4'/./9 ,' %$/.*'*4!' '+*3!4' *#4,$'% 

    RMN 3'!* -#$&$ /$% 3!, $* $, &!'+*/3!4. -%$-'%3. &$ -,'4$*3'/ '*.%',$/S! $, &!'+*/3!4. 4,*!4. &$ #*' -,'4$*3' '&($%$*3$ '*.%', (' /!&. %$',!7'&' $* $,

    -./-'%3.9 &$!&. ' ,' !*4'-'4!&'& -'%' ,.4',!7'% $, -,'*. &$ 4,!')$ $*3%$ $, 3$%.

    ,' -,'4$*3'9 #*' !-.%3'*3$ &$4!/!* &$$ /$% 3.'&': 4.*/$%'% $, 3$%. .

    $8$43#'% (!/3$%$43.' U* !*3$*3. -$%/!/3$*3$ -'%' $*4.*3%'% $, -,'*. &$

    /$-'%'4!*9 &.*&$ *. $!/3$9 -#$&$ 4.*,,$'% ' #* &$/'/3%$9 ' "#$ ,' ($.%%'+!'

    -#$&$ /$% +!+'*3$/4'S$ (' -%.'&. $* $/3./ 4'/./ "#$ ,' (!/3$%$43.' $/ ,' $).% ',3$%*'3!' ,'

    .%3',!&'& '3$%*' $/ ')' $* 4.-'%'4!* 4.* #* '*$). 4.*/$%'&.%L'

    (!/3$%$43.' $/3 4,'%'$*3$ !*&!4'&' /! ,' -%&!&' /'*+#*$' $/ $4$/!' . ,'

    4.*/$%'4!* &$ 8$%3!,!&'& ' *. $/ #*' .-4!* E* $, 4'/. &$ -,'4$*3' -$%4%$3'9 ,'

    .%3',!&'& (' /!&. %$!&' ' #* 2 4.* #*' (!/3$%$43.' 3$-%'*'E, '*$). 4.*/$%'&.% $/ #*' .-4!* ,!&' /! /$ #/4' ,' -%$/$%'4!* &$ ,'

    8$%3!,!&'& A,+#*'/ 4.*+'/ 4.*/$%'&.%'/ ('* /!&. &$/4%!3'/:1 D$)'% ,' -,'4$*3' $* /# ,#+'% 3.3',$*3$ . $* 8%'+$*3./2 L.4',!7'% $, 4.%3$ /#3#%'%? V',.%'% $, &$8$43.9 $/-$4!',$*3$ /! ,' -,'4$*3' -$%4%$3' $/ !&$*3!8!4',$ L$+%'&. 4#%$3')$

     A,+#*./ 4'/./ ('* /!&. '*$)'&./ &$)'*&. ,' -,'4$*3' $*3$%' $* /# ,#+'%

    ,!+'*&. $, 4.%&*9 $/-$%'*&. "#$ ,' -,'4$*3' 4.* $, 3!$-. /$ '3%.8!$ O3%./

    /#+!$%$* #*' %$.4!* &$ ,' -,'4$*3' 4.. /$' -./!,$9 /!* 4'#/'% !*4%$$*3. $*

    ,' ($.%%'+!'9 /$+#!&. &$ #* '/')$ #3$%!*.9 .!3.4!*'9 '*3!!3!4./ $&!&'/

    ?

  • 8/17/2019 TESIS 21 FIN 2.docx

    36/78

    -'%' #*' /#/$4#$*3$ %$.4!* &$ -,'4$*3' 4.. 4#%$3')$9 #*' $7 "#$ ,'

    ($.%%'+!' (' /!&. 4.*3%.,'&'E, '*$). 4.*/$%'&.%9 /!* $'%+. *. $/3 ,!%$ &$ %!$/+./Q ,' $3%'44!* '*#',

    -#$&$ $/3'% '/.4!'&' 4.* !*4%$$*3. &$ ($.%%'+!' 9!*8$44!* %.3#%' L'($.%%'+!' -./-'%3. $/ / 4.* $* 4'/./ $* "#$ ,' -,'4$*3' $/ $3%'&'

    '*#',$*3$ &$ #*' '*$%' '+%$/!' E, 4#%$3')$ -#$&$ '#$*3'% ,' !*4!&$*4!'

    &$ #*' !-,'*3'4!* '*.%', &$ ,' -,'4$*3' $* #* $'%'7. /#/$4#$*3$ S$

    &$$ $/4.+$% $, -,'* &$ '*$). &$ '4#$%&. ' ,' 4'-'4!&'& &$, .-$%'&.% ',

    /.-.%3$

    DESGARROS OBSTWTRICOSC.*/3!3#$* ,' /$+#*&' 4'#/' &$ ($.%%'+!' -./-'%3. E, &'. &$, 3%'43. +$*!3',

    -#$&$ .4#%%!% $/-.*3*$'$*3$ . -.% '*!-#,'4!* #/'&' -'%' ,' $3%'44!* &$,

    8$3.E, 3%'#'3!/. -#$&$ .4#%%!% ,#$+. &$ #* 3%''). &$ -'%3. -%.,.*+'&.9

    $/-$4!',$*3$ $* -'4!$*3$/ 4.* &$/-%.-.%4!* 48',. -,!4' %$,'3!' . '/.,#3'

    $* 3$%. "#$ (' /!&. $/3!#,'&. 4.* .!3.4!*' . -%./3'+,'*&!*'/E, 3%'#'3!/. -#$&$ .4#%%!% ,#$+. &$ ,' '*!-#,'4!* !*3%'#3$%!*' &$, 8$3. $!/3$

    %!$/+. ',3. '/.4!'&. ' $%/!* $3$%*' F!*',$*3$9 3'!* -#$&$ .4#%%!% ,#$+. &$

    '*!-#,'4!* -'%' $3%'44!* '*#', &$ ,' -,'4$*3'L' %.3#%' #3$%!*' $/ / 8%$4#$*3$ $* -'4!$*3$/ 4.* 4$/%$' -%$!' L'/

    ,'4$%'4!.*$/ 4$%!4',$/ /.* / 4.*$*3$ '/.4!'&'/ ' #3!,!7'4!* &$, 8%4$-/Q

    -.% $,,.9 $/ "#$ $, 4#$,,. &$$%' /$% !*/-$44!.*'&. ,#$+. &$ $/3./

    -%.4$&!!$*3./

    INVERSIN UTERINA

    ?5

  • 8/17/2019 TESIS 21 FIN 2.docx

    37/78

    L' !*$%/!* #3$%!*' $/ #*' 4.-,!4'4!* -.3$*4!', &$, 3%'3'!$*3. &$ ,' 3$%4$%'

    8'/$ &$, 3%''). &$ -'%3. E, &!'+*/3!4. 3$-%'*. ,' 4.%%$44!* /.* '*&'3'%!./

    -'%' %$!% ,' .%!.%3',!&'& G$*$%',$*3$9 /# -%$/$*3'4!* $/ #*' &$ 2 5009

    -$%. 3!$*$ #* %'*+. # '%!',$

    S! ,' -,'4$*3' /$ (' /$-'%'&. $, 3$%. $/3 4.*3%'&.9 #*' /#'$ 3%'44!* &$,

    4.%&* &$$%' %$/#,3'% $* #* ',#%'!$*3. %$,'3!'$*3$ 84!, S! $/3' '*!.%'

    $/ %$',!7'&' !$*3%'/ ,' -,'4$*3' /!+#$ '&($%!&' . $, 3$%. %$,')'&.9 $, %!$/+. &$

    !*$%/!* &$, 3$%. $/ '%4'&'$*3$ '#$*3'&.9 $/-$4!',$*3$ /! ,' -,'4$*3'

    $/3 !-,'*3'&' $* $, 8.*&. &$, 3$%. L' -,'4$*3' 4%$3' -#$&$ !*4%$$*3'% $,

    %!$/+. &$ !*$%/!* E/ 4,'%. "#$ ,' !*4!&$*4!' -'%4!',$*3$ &$-$*&$ &$ ,'

    $-$%!$*4!' &$, .-$%'&.% O3%./ 8'43.%$/ $3!.,+!4./ !*4,#$* ,' -%$/!* &$, 8.*&.9

    3%'44!.*$/ $4$/!'/ &$, 4.%&*9 4.%&* -$"#$.9 '4!'!$*3. %$-$*3!*. &$ #*

    3$%. &!/3$*&!&. $3%'44!* '*#',E, -%!*4!-', /!+*. &$ ,' !*$%/!* #3$%!*' $/ ,' ($.%%'+!'9 "#$ .4#%%$ $* / &$

    = &$ -'4!$*3$/9 4.* #*' -%&!&' $/3!'&' &$ /'*+%$ $*3%$

  • 8/17/2019 TESIS 21 FIN 2.docx

    38/78

    &$ ,' $3%'44!* &$ ,' -,'4$*3' L./ 4'/./ &$ -%&!&'/ 4#'*3!./'/ /'*+#*$'/ /$

    ('* &'&. -.% %$.4!.*$/ -%$!'/ &$ -,'4$*3'S! #* '%. 4$%!4', $/ -',-',$9 $, 8.*&. &$$ /$% 3.4'&. 4$%4' &$, '%. S! ,./

    !*3$*3./ !*!4!',$/ &$ %$-./!4!* /.* !*3!,$/9 (' / .-4!.*$/ "#$ $/3*&!/-.*!,$/ I*3$*3./ $!3././ &$ %$-./!4!.*'!$*3. ('* /!&. 4.#*!4'&./

    &$/-#/ &$ ,' '&!*!/3%'4!* &$ /#,8'3. &$ '+*$/!. 9%!3.&%!*' . 3$%#3',!*' E,

    /#,8'3. &$ '+*$/!. $/ -%$8$%!&. $* #)$%$/ "#$ /.* (!-.3$*/'/ L' *!3%.+,!4$%!*'

    !*3%'$*./' (' /!&. &$/4%!3' 4.. #* %-!&. %$,')'*3$ #3$%!*.9 #/'&. -'%' ,'

    !*$%/!* #3$%!*' S! '* /!+#$ /!$*&. 8',,!&. $, !*3$*3. 9,' '*$/3$/!' +$*$%', 4.* #*

    '+$*3$ (',.+$*'&. -#$&$ /$% *$4$/'%!' E/3. -#$&$ %$,')'% $, '%. 4.*/3%!43.%9 $,

    3$%. &$ '*$%' !-.%3'*3$ ' ,' -'4!$*3$ U*' $7 "#$ $, 3$%. $/

    %$-./!4!.*'&.9 ,' -,'4$*3' &$$ /$% %$.!&' '*#',$*3$ &$3$*$% ,./

    %$,')'*3$/ O!'$*3$9 ,' %$,')'4!* #3$%!*' !*4%$$*3' -.3$*4!',$*3$ $, %!$/+.

    &$ ($.%%'+!' E*3.*4$/9 3'* -%.*3. /$ (' 3$%!*'&. $, -%.4$&!!$*3.9 &$$

    !*!4!'%/$ $, 3%'3'!$*3. 4.* #3$%.3*!4./T.&./ $/3./ -%.4$&!!$*3./ -#$&$* -%$$*!% ,' .%3',!&'& '3$%*' ,' '.% 

    .%!,!&'& %$,'4!.*'&' ' ,' 3%'*/8#/!* L' ,'-'%.3.' -'%' ,' !*$%/!* #3$%!*'

    %'%'$*3$ $/ *$4$/'%!'9/! ,./ !*3$*3./ &$ %$-./!4!.*'!$*3. /.* %-!&'$*3$

    !*!4!'&./

    ROTURA UTERINAL' %.3#%' #3$%!*' /$ -%$/$*3' 4.* /(.4 9&.,.% /'*+%'&. &$ !*3$*/!&'& '%!',$

    ,' -%&!&' &$ /'*+%$ -#$&$ /$% '#*&'*3$ . *!' +$*$%',$*3$ 3!$*$ 4..

    '*3$4$&$*3$ 4$/%$' -%$!' /$ -%'43!4'%' ,' ,'-'%.3.' !*$&!'3'$*3$ /$

    ?;

  • 8/17/2019 TESIS 21 FIN 2.docx

    39/78

    %$',!7'%' ,' (!/3$%$43.' .9 /! ,' /!3#'4!* ,. -$%!3$ ,' #)$% &$/$' +$/3'% 

    *#$'$*3$9 $, %$-'%. "#!%%+!4. &$ ,' %.3#%' 94.* ',!*$'!$*3. &$ ,./ .%&$/

    2;KPREVENCIN DE LA HEMORRAGIA POSTPARTO

    E* #4(./ -'/$/ $* &$/'%%.,,. 3.&'' /$ #/' $ '*$). $-$43'*3$ &$ ,' 3$%4$%'

    $3'-' &$, -'%3. "#$ .4#%%$ $* $, (.+'% S!* $'%+. 4.* $, '*$). '43!. /$

    .3!$*$ #*' !*4!&$*4!' $*.% 59= $%/#/ $, '*$). $-$43'*3$ 1;9=

    E, '*$). '43!. &$ ,' 3$%4$%' $3'-' &$, -'%3. 4.-%$*&$ :

    P'/. 1 –'&!*!/3%'4!* &$ .!3.4!*' # .3%. $&!4'$*3. #3$%.3.*!4. &$*3%. &$ 1

    !*#3. ,#$+. &$, *'4!!$*3. &$, %$4!* *'4!&./$ '&!*!/3%' .!3.4!*' 10 UI !9/!

    *. (' .!3.4!*' &!/-.*!,$ /$ -#$&$ #/'% 600 4+ &$ !/.-%./3., . O3%./

    #3$%.3.*!4./ 092 + ! &$ $%+.$3%!*' . $3!$%+.$3%!*'

    P'/. 2K 3%'44!* 4.*3%.,'&' &$, 4.%&* ,#$+. &$ -!*7'% 4.%3'% $, 4.%&* #!,!4',

    4#'*&. (' &$)'&. &$ ,'3!% ' ,./ 2 . ? !*#3./ &$, -'%3. N. /$ &$$ %$',!7'% ,'

    3%'44!* /!* '-,!4'% ,' 4.*3%'3%'44!.* -.% $*4!' &$, -#!/ 4.* ' .3%' '*.

    P'/. ?K'/')$ #3$%!*. ' 3%'$7 &$, '&.$* &$/-#/ &$ ,' $-#,/!* &$ ,'

    -,'4$*3' 9 '#&' ' "#$ $, #3$%. /$ 4.*3%'!+'9 &!/!*#$*&. $, /'*+%'&.

    ,' '/.4!'4!* 4.* '*$!' $/ !-.%3'*3$ -.%"#$ *. /.,. -%$&!/-.*$ ' ($.%%'+!'

    -./3-'%3. /!*. "#$ %$$ ,' 3.,$%'*4!' ' ,' -%&!&' &$ /'*+%$ E, 3%'3'!$*3. &$

    ,' '*$!' -.% &$8!4!$*4!' &$ (!$%%.

    ?

  • 8/17/2019 TESIS 21 FIN 2.docx

    40/78

    2

  • 8/17/2019 TESIS 21 FIN 2.docx

    41/78

    CLASIFICACIN DE HEMORRAGIA SEGYN SU GRAVEDAD

    PERDIDA

    HEMATICA

    TENSION

     ARTERIAL/

    FRECUENCIA

    CARDIACA

    DIURESIS

    CLASE

    H'/3' ;50, .

    ('/3' 15 &$

    .,$!'

    S!* ',3$%'4!.* FCX100!*

    D!#%$/!/ ?0 ,(

    I C.-$*/'&.

    ;50 ' 1500 , .

    15K?0 &$ .,$!'

    *.%', FC100K120!*

    D!#%$/!/ 20K?0

    ,(

    II (!-..,$!' ,$$

    1500 ' 2000, .

    ?0K 0 &$ .,$!'

    &!/!*#!&' &$ ;0 '

  • 8/17/2019 TESIS 21 FIN 2.docx

    42/78

    RELACION ENTRE GRAVEDAD DE SHOC EVOLUCION

    S(.4 4.-$*/'&. 4,'/$

    I

    M$4'*!/.

    4.-$*/'4!* '/$+#%'

    8,#). $* %+'*./ !3',$/

    C&!+. ''%!,,. ','%'

    S(.4 &$/4.-$*/'&.

    -$%. %$$%/!,$4,'/$ II III

    C.* $&!&'/

    3$%'-#3!4'/ '&$4#'&'/

    /.%$!$

    C&!+. %.). #,3!'

    .-.%3#*!&'& &$ /','%

    !&'S(.4 !%%$$%/!,$ 4,'/$ IV E, 3%'3'!$*3. 8#$

    !*/#8!4!$*3$ . /$

    &$.%.9,' -'4!$*3$

    .%!%'

      

    F#$*3$ :/(.4 ($.%%+!4. &$ EM',!*. 2010

    2=KLABORATORIO

    E/3#&!./ &$ ,'.%'3.%!. L./ $/3#&!./ '*3$*'3',$/ &$$* !*4,#!% !.$3%' ($3!4'

    S! /$ $*4#$*3%' '*$!'9 $/3 !*&!4'&' ,' !*3$%$*4!* -'%' $).%'% ,'

    ($.+,.!*'

    1

  • 8/17/2019 TESIS 21 FIN 2.docx

    43/78

    L./ ',.%$/ &$ ($.+,.!*' $* ,' ',3#%' '.% &$ 1?9; $* &!4(' 4!8%' $/3' !*4,#!&.

    $, 8'43.% &$ 4.%%$44!* [29;L' 3!-!8!4'4!* -%#$'/ 4%#7'&'/ &$$* /$% %$',!7'&'/ ,. / -%.*3. -./!,$9 '/

    4.. ,'/ -%#$'/ &$ 4.'+#,'4!*

    210KMANEJO DE LA HEMORRAGIA POSTPARTO

    E/ # !-.%3'*3$ '43#'% 4.* -%.*3!3#& 4#'*&. $/3'./ 8%$*3$ ' #*' ($.%%'+!'

    -./3-'%3. T$*$% $* 4#$*3' "#$ -.% ,' '%3$%!' #3$%!*' 4!%4#,'*

  • 8/17/2019 TESIS 21 FIN 2.docx

    44/78

    2K-$&!% '#&':C'&' C$*3%. &$$%' 3$*$% #* -%.3.4.,. &$ '*$). &$ ,' ($.%%'+!' ./33%!4'

    4%3!4'9 "#$ #*' $7 '43!'&. .!,!4$ $* 3!$-. 8.%' $, -$%/.*', ,./ %$4#%/./

    '-%.-!'&./?KM.*!3.%$. &$ ,' -'4!$*3$:EG 9-%$/!* '%3$%!',9 .!$3%' &$ -#,/. &!#%$/!/ (.%'%!' /.* '*&'3.%!'/C.*/!&$%'% ,' 4.,.4'4!* &$ #*' ' 4$*3%', /! ,' -'4!$*3$ $/3 !*$/3',$T.'% #$/3%'/ -'%' ,'.%'3.%!.: %$4#$*3. &$ +,.#,./ %.)./9 H39 H

    4.'+#,.+%'' !*4,#$*&. -%.+./ &$ &$+%'&'4!* &$ ,' 8!%!*' $/3'&. 4!&.K

    '/$9$,$43%.,!3./9#%$'94%$'3!*!*'KI*!4!'% %$/#/4!3'4!*:E, .)$3!. $/ %$/3'#%'% $, .,#$* &$ /'*+%$ 4!%4#,'*3$ '*3$*$% #*' '&$4#'&'-$%8#/!* 3!/#,'%KM'*3$*$% !' '$%$' -$%$',$KO+$*.: 10 ,!3%./ -.% !*#3.KD./ 4'*#,'/ &$ 4',!%$ 1 . 16 &$$* /$% 4.,.4'&'/ &$ !*$&!'3.94.* /.,#4!.*$/

    &$ 4.,.!&$/ $) H'$'44$, 4.%%!$*&. -.% #*' &$ $,,'/ &$ 4%!/3',.!&$/ $) R!*+$% 

    L'43'3. -.% ,' .3%' !$*3%'/ /$ '+#'%&' ,' ,,$+'&' &$ /'*+%$ &$%!'&./ 94.* ,'

    -%$4'#4!* &$ $*3!!'%,./ '*3$/ $-,$'*&. '*+#!3./ &$ 4.-%$/!* /! $, 4'/.

    ,. %$"#!$%$4%!/3',.!&$/ ('/3' 2 ,!3%./Q4.,.!&$/ ('/3' 15 ,!3%./E, '*4. &$ /'*+%$ &$$ $/3'% $* 4.*&!4!.*$/ &$ -%.$$% :6U &$ G,#,./ R.)./

    D$/-,'/'3!7'&./ GRD9 6 U &$ -,'/' 8%$/4. 4.*+$,'&. PFC 96 U &$

    4.*4$*3%'&. &$ -,'"#$3'/ 10 U &$ 4%!.-%$4!-!3'&./E-$%!$*4!'/ %$4!$*3$/ &$#$/3%'* ,'/ $*3')'/ &$ *. &$.%'% ,' %$-./!4!* &$

    8'43.%$/ &$ ,' 4.'+#,'4!* 9'&!*!/3%'*&. PFC $* #*' %$,'4!* 1:1 . 1:2 4.* ,'

    3%'*/8#/!* &$ GRDL./ .)$3!./ ' ',4'*7'% /.*:KF!%!*+$*.9 100 +&LKH$'3.4%!3. 21 ($.+,.!*' ; +&LKR$4#$*3. &$ -,'"#$3'/9 50^10?_LKT!$-. &$ -%.3%.!*' APTT9 X 15 3!$-./ 4.*3%., R$,'4!* I*3$%*'4!.*',

    N.%',!7'&' RIN X15 U* $4$/. &$ !*8#/!.*$/ -#$&$ &$%!'% $* $&$' '+#&. &$ -#,* . $* #*'

    4.'+#,.-'3' -.% &!,#4!* E/ # !-.%3'*3$ $!3'% ,' (!-.3$%!' 9-#$/ .&!8!4' ,'

    ?

  • 8/17/2019 TESIS 21 FIN 2.docx

    45/78

    4'/4'&' &$ ,' 4.'+#,'4!* $, 3.*. '/..3.%9 S! /$ &$3$43'* '4!&./!/

    (!-.4',4$!' 9&$$* /$% 4.%%$+!&'/ %'-!&'$*3$L'/ -'4!$*3$/ 4.* 8'43.%$/ &$ %!$/+. &$$ /$% %$!/'&'/ -$%!&!4'$*3$ -'%' #*

    '*$). %-!&.9/# $/3'&. +$*$%',9 ,' 4'*3!&'& &$ /'*+%'&. ,' %$/-#$/3' !*!4!', ','*$).5KD$3$*$% ,' ($.%%'+!':L' -%!$%' $&!&' ', 4.*/3'3'% ,' '3.*' #3$%!*' $/ $8$43#'% '/')$ 4.-%$/!.

    #*!8.%$ /#'$ &$, %+'*. A&!*!/3%'% $&!4'4!* 3$%.K%$3%'43.%''O!3.4!*'E/ $, 8%'4. &$ -%!$%' $,$44!* 910 UI &$ .!3.4!*' &!,#!&'/ $* 500 L $*

    !*8#/!* !*3%'$*./' 3%'/ $, ',#%'!$*3. #/#',$*3$ $/ /$+#!&. -.% #*'

    !*8#/!* &$ 0 #*!&'&$/ %'*3$ (.%'/E* ,'/ -'4!$*3$/ (!-..,$!4'/ &$$* $-,$'%/$ &./!/ $*.%$/9 -#$/ -#$&$

    .4#%%!% #*' (!-.3$*/!* $3%$' -.% '/.&!,'3'4!* M$3!,$%+.$3%!*'E/ #* #3$%.3*!4. -.3$*3$ 4'&' '-.,,' &$ 1, 4.*3!$*$ 092 + E, 4.!$*7. &$'44!* 3!$*$ ,#+'% 2K5 !*#3./ &$/-#/ &$ ,' '&!*!/3%'4!* IM L' %'4!* $/ &$'-%.!'&'$*3$ K6 (.%'/ L'/ !*$44!.*$/ IV *. /$ %$4.!$*&'* -#$/ /$ ('*&$/4%!-3. '44!&$*3$/ 4'%&!.'/4#,'%$/ '3$%*./ +%'$/ L' (!-$%3$*/!* '%3$%!', $/

    #*' 4.*3%'!*&!4'4!* -'%' /# $-,$.4 C'%$3.4!*'

     A*,.+. /!*33!4. &$ ,' .!3.4!*' "#$ -./$$ #*' '44!* -%.,.*+'&' -%.-!$&'&$/

    '+.*!/3'/9 #*!*&./$ ' /#/ %$4$-3.%$/ $* ,' #/4#,'3#%' ,!/' #3$%!*'9 -%.!$*&.

    4.*3%'44!.*$/ %3!4'/ &$, 3$%.9 '#$*3. &$ ,' 8%$4#$*4!' &$ 4.*3%'44!.*$/

    $!/3$*3$/ '#$*3. &$ ,' 3.*!4!&'& &$ ,' #/4#,'3#%' #3$%!*' E, 4.!$*7. &$ ,'

    4.*3%'44!* #3$%!*' ' -'%3!% &$ /# '&!*!/3%'4!* /$ -%.$ ' ,./ &./ !*#3./ 4.*

    #*' %'4!* &$ 60 !*#3./ IV 120 !*#3./ IM S$ -#$&$ '&!*!/3%'% $* 8.%'

    IV $* .,. ,$*3. $* -.% ,. $*./ 1 !*#3. '44!* !*$&!'3' . IM S$ #3!,!7' #*'

    *!4' &./!/ &$ 100 + 1,& M!/.-%./3.,

  • 8/17/2019 TESIS 21 FIN 2.docx

    46/78

    E/ #* '*,.+. /!*33!4. &$ ,' PGE 1 /$ '&!*!/3%' -.% !' %$43', /$ $4%$3'

    -%!*4!-',$*3$ -.% ,' .%!*' S$ ('* !*8.%'&. $8$43./ &./!/ –&$-$*&!$*3$/ 4..:

    4,!4./9 &!'%%$'/9 !3./9 $-!+'/3%',+!'/9 4$8',$'/9 $'*3$' 4#3*$.9 '%$./9

    (!-.3$*/!* '%3$%!', $ (!-$%3$%!' S$ 4.*3%'!*&!4' $* -'4!$*3$/ 4.* '*3$4$&$*3$/

    &$ '/' %.*"#!',9 #%3!4'%!' # .3%'/ -'3.,.+'/ &$ $3!.,.+' ',%+!4' $

    (!-$%/$*/!!,!&'& ' ,./ &$%!'&./ -%./3'+,'*&*!4./ P./$$ ,' $*3')' &$ -$%!3!% 

    /# ','4$*'!$*3. ' 3$-$%'3#%' '!$*3$9 $* %$4!-!$*3$ 4$%%'&.

    S$+* ,'/ %$4.$*&'4!.*$/ &$ ,' FIGO 2012 $* #* 4.*3$3. &$ ')./ %$4#%/./:E, #/. &$ !/.-%./3., $/ (. $* &' #*' !*3$%$*4!* %$4.*.4!&' $* $, 3%'3'!$*3.

    &$ ,' HPP9 -'%3!4#,'%$*3$ $* ,'/ !*/3!3#4!.*$/ (./-!3','%!'/ &$ ')' 4.-,$)!&'&

    &$ '3$*4!* $* /',#&

  • 8/17/2019 TESIS 21 FIN 2.docx

    47/78

    $*.%%'+!' -$%. /# #/. $* HPP $/ $'!*'&. &$ *#$. &'&. "#$ %$!%' $,

    /'*+%'&. !*&$-$*&!$*3$$*3$ /! /$ 3%'3' &$ '3.*' #3$%!*' . ,'4$%'4!.*$/12

    M'*$). $* ,' %$3$*4!* &$ %$/3./ -,'4$*3'%!./ . $%'*'/: S! $, &!'+*/3!4.

    4.%%$/-.*&$ ' %$3$*4!* &$ 3$)!&./ -,'4$*3'%!./ . $%'*'/ &$ ,' -,'4$*3' 9/$

    &$$ $8$43#'% ,. / -%.*3. -./!,$ ,' %$!/!* $3%'44!* &$ ,./ 3$)!&./ L'

    -'4!$*3$ %$"#!$%$ '*$/3$/!'

    M'*$). $* $, 3%'#'3!/. +$*!3', &$/+'%%./: E, 3%'#'3!/. +$*!3', $/3 ,!+'&.

    ' #* /'*+%'&. -$%/!/3$*3$ 9+$*$%',$*3$ $* $*.% 4'*3!&'& "#$ ,' %$3$*4!* &$

    3$)!&./ ,' '3.*' #3$%!*'L./ &$/+'%%./ +$*!3',$/ &$$* /$% $',#'&./ 4#!&'&./'$*3$ %$-'%'&./9

    -.*!$*&. '3$*4!* $* $!3'% ,' 8.%'4!* &$ ($'3.'/ $* ,' %$+!* S$

    %$4.!$*&' %$',!7'% $/3$ -%.4$&!!$*3. '). '*$/3$/!' +$*$%',;

    6KM'/')$ 4.-%$/!. !'*#', &$, 3$%.S$ !*/$%3' #*' '*. $* ,' '+!*' /$ 4!$%%' 4.*8.%'*&. #* -#. E/3' '*. /$

    /!3' $* $, 8.*&. &$ /'4. '*3$%!.% /$ '-,!4' -%$/!* 4.*3%' ,' -'%$& '*3$%!.% &$,

    3$%. C.* ,' .3%' '*.9 -%$/!.*'% -%.8#*&'$*3$ $, '&.$* &$3%/ &$, 3$%.9

    '-,!4'*&. -%$/!* 4.*3%' ,' -'%$& -./3$%!.% &$, %+'*. M'*3$*$% ,' -%$/!* ('/3'

    "#$ $, /'*+%'&. /$' 4.*3%.,'&. $, 3$%. /$ $*4#$*3%$ !$* %$3%'&.

    L' 4.-%$/!* '.%3!4' /$ 4%$$ "#$ $/ # $8!4'7 9$/ #*' 8.%' &$ %$!% $, 8,#).

    &$ /'*+%$ ('4!' $, 3$%.9 /$ -#$&$ '*3$*$% %'*3$ / &$ 1 (.%' 93!,

    $/-$4!',$*3$ $* -,'4$*3'/ %$3$*!&'/ "#$ $/3* /'*+%'*&. $* +%'* $&!&' 9

    !$*3%'/ $/-$%'* ,' $3%'44!* '*#', &$ ,' -,'4$*3'12

    ;KT4*!4'/ -'%' $, 4.*3%., ,.4', &$, /'*+%'&.KT4*!4'/ 4.-%$/!'/ !*3%'#3$%!*'/ 3'-.*'!$*3.:A,+#*./ ,'/ 4.*&$*'*

    '/$+#%'*&. "#$ /.* !*$8$43!'/ -$,!+%./'/ &$!&. ' "#$ %$3%'/'* $, !*!4!. &$,

    6

  • 8/17/2019 TESIS 21 FIN 2.docx

    48/78

    3%'3'!$*3. "#!%%+!4.Q /!* $'%+. .3%./ '#3.%$/ %$-.%3'%.* ',3'/ 3'/'/ &$ !3.

     A*3$/ &$ %$',!7'%,'/9 &$$* /$% $4,#!&'/ ,'/ ,$/!.*$/ '+!*',$/ 4$%!4',$/

    M!$*3%'/ $, 3$%. $/3 4.-%!!&.9 /$ &$$ 4.*3!*#'% ,' %$-./!4!* &$ 8,#!&./

    /'*+%$ '&!*!/3%'% '*3!!3!4./ S$ %$3!%'* ' ,'/ 2 (.%'/ /! *. 4.*/!+#$*

    4.*3%.,'% ,' ($.%%'+!' *. &$$* %$4.,.4'%/$ T'-.4. /$ &$$ !*/!/3!% $*

    '*3$*$% $, 3$%. 4.-%!!&. -.% / &$ 2 (.%'/ $* #* !*3$*3. -'%' `/','%` $,

    3$%. . $!3'% ,' ,'-'%.3.'P#$&$* #3!,!7'%/$ -'%' ,' 4.-%$/!* !*3%'#3$%!*':

      G'/': S$ %$,,$*' ,' 4'!&'& #3$%!*' 4.* #*' +'/' ,'%+' $* 8.%' #*!8.%$

    4.-,$3' N. #3!,!7'% +'/'/ -$"#$'/ -.% ,' -./!!,!&'& &$ .,!&. ', /$% %$3!%'&'/  S.*&' &$ F.,$: L' 34*!4' $/ /!-,$ S$ #3!,!7' #*' /.*&' Na 29 ,' -#*3' $/

    +#!'&' &$*3%. &$ ,' 4'!&'& #3$%!*' $, ',* /$ %$,,$*' 4.* 60 '

  • 8/17/2019 TESIS 21 FIN 2.docx

    49/78

    8%'4./ #3$%.3*!4./ (''* 8%'4'/'&.9 ,.+%*&./$ #4('/ $4$/ 4.*/$%'% ,'

    8$%3!,!&'& U* #$* !*&!4!. -%$!. ' ,' #3!,!7'4!* &$ $/3'/ 34*!4'/ $/ ,'

    4.-%.'4!* &$, 4$/$ &$, /'*+%'&. 4.* ,' 4.-%$/!* !'*#', &$, 3$%. ' '

    4!$,. '!$%3.S#3#%' &$ BKL*4( E* 1==;9 BKL*4( C.$% &$/4%!!$%.* $/3' 34*!4' -'%'

    4.*3%.,'% $, /'*+%'&. $* #* 4#'&%. &$ '3.*' #3$%!*' 4#'*&. .3%./ 3.&./ (''*

    8',,'&. E/ %$,'3!'$*3$ /!-,$ &$ '-%$*&$%9 /$+#%'9 4.*/$%' ,' 4'-'4!&'&

    %$-%.+!' $* 4'/. &$ 8',,'%9 -$%!3$ ,' %$',!7'4!* &$ .3%'/ !*3$%$*4!.*$/ /

    %'&!4',$/ L' 34*!4' $/ ,' /!+#!$*3$:1 E, '&.$* $/ '!$%3. $&!'*3$ #*' !*4!/!* &$ 3''. '-%.-!'&. . %$'-$%3#%'

    &$ ,' !*4!/!* $* 4'/. &$ 4$/%$'2 L#$+. &$ %$4('7'% /#8!4!$*3$$*3$ ,' $)!+' #*' $7 ',4'*7'&. $, 3$%. /$

    %$',!7' #*' !*4!/!* $* ,$ /$+$*3. !*8$%!.% #3$%!*. . /.* ,!$%'&'/ ,'/ /#3#%'/ &$

    ,' (!/3$%.%%'8!' $* $, 4'/. &$ #*' 4$/%$' D$ $/3' '*$%' /$ '44$&$ ' ,' 4'!&'&

    #3$%!*' -'%' $'!*'%,'9 ,!-!'%,' $$*3#',$*3$ $'4#'%,'? E, 3$%. $/ $3$%!.%!7'&. %$$',#'&. -'%' !&$*3!8!4'% ',+* /$43.% /'*+%'*3$

    S$ &$$ %$',!7'% 4.-%$/!* !'*#', -%!$%. -'%' '#$*3'% ,'/ -%.'!,!&'&$/

    &$ !3. &$ ,' /#3#%' ' '-,!4'% S$ &$/4%!$ ,' 34*!4' -'%' #* 4!%#)'*. /!3#'&. ' ,' !7"#!$%&' &$ ,' -'4!$*3$'K S$ #3!,!7' #*' '+#)' 4#%' &$ ;0 &$ ,.*+!3#& 4.* #*' /#3#%' &$ 4'3+#3

    4%.'&. *$%. 2 /$ 4.,.4' $* -%!$% -#*3. $* $, 3$%. ' ? 4 &$'). &$,

    .%&$ ,'3$%', &$%$4(. &$ ,' !*4!/!* #3$%!*' ' ? 4 &$, .%&$ ,'3$%', &$%$4(. &$,

    3$%.K L' '+#)' '(.%' '3%'!$/' ,' 4'!&'& #3$%!*' -'%' $$%+$% ? 4 -.% $*4!' &$,

    '%+$* &$ ,' !*4!/!* #3$%!*' ' 4 &$, .%&$ ,'3$%', &$, 3$%. -.%"#$ $, 3$%.

    /$ $*/'*4(' &$/&$ ''). ('4!' '%%!'4K L' /#3#%' 4%!4'9 '(.%' *#$'$*3$ !/!,$9 $/ -'/'&' /.%$ $, 8.*&. 3$%.

    4.-%!!&. '-%.!'&'$*3$ ' ?K 4 &$, .%&$ &$, 4#$%*. #3$%!*. &$%$4(.

  • 8/17/2019 TESIS 21 FIN 2.docx

    50/78

    &K E, 4'3+#3 $/ 3%'44!.*'&. $%3!4',$*3$ &$3%/ &$, 3$%. !$*3%'/ $, '#&'*3$

    4.*3!*' 4.-%!!$*&. $, 3$%.$K S$ &' #* -#*3. 4.* .%!$*3'4!* (.%!7.*3', $* ,' -'%$& -./3$%!.% &$, 3$%. ' *!$,

    &$ ,' 4'%' -./3$%!.% &$%$4(' &$, /$+$*3. #3$%!*. !*8$%!.% $*3%'*&. ' ,' 4'!&'&#3$%!*'9 ' ,' !/' ',3#%' $* ,' "#$ /$ 4.,.4 $, -#*3. /#-$%!.% $* ,' 4'%' #3$%!*'

    '*3$%!.%9 /',!$*&. -.% ,' 4'%' -./3$%!.% !7"#!$%&' &$, /$+$*3. #3$%!*. !*8$%!.%8K L' /#3#%' $/ 3%'44!.*'&' $* 8.%' $%3!4', *#$'$*3$ $/ -'/'&' /.%$ $,

    8.*&. #3$%!*. /.%$ $, ,'&. !7"#!$%&. &$ '3%/ ('4!' &$,'*3$ 4.-%!!$*&. '/ $,

    3$%. /.%$ ,' !7"#!$%&' &$ ,' !/' '*$%' "#$ ,. (!7. /.%$ ,' &$%$4('+K C.* ,' '+#)' /$ $*3%' ' ,' 4'!&'& #3$%!*' $* $, ,'&. !7"#!$%&. '*3$%!.% $* 8.%'

    /!!,'% ' ,. ($4(. $* ,'&. &$%$4(. -$%. $/3' $7 4.$*7'*&. -.% $*4!' &$ ,'

    !*4!/!* #3$%!*' /',$ ? 4 &$'). &$, '%+$* &$ &!4(' !*4!/!*(K L'/ &./ -#*3'/ &$ ,' /#3#%' /.* 8!%$$*3$ 3%'44!.*'&'/9 !$*3%'/ $, '/!/3$*3$

    *#$'$*3$ 4.-%!$ $, 3$%. 4.* ''/ '*./ E/3. /$ %$',!7' -'%' !*!!7'% 

    $, 3%'#'!K C.* ,' 4.*3!*#' 4.-%$/!* &$, 3$%.9 $, 4!%#)'*. -%!*4!-', %$',!7' #* *#&. &.,$

    /$+#!&./ -.% 2 . ? *#&./ / -'%' '/$+#%'% ,' 3$*/!*5 C$%%'% ,' !*4!/!* 3%'*/$%/' /.%$ $, /$+$*3. #3$%!*. $* ,' 8.%' ('!3#',

      A%#,#'%'*9 H''* 4.,/ -#,!4'%.* #*' *#$' 34*!4' &$ /#3#%' 4.-%$/!'

    '/'&' $* ,' 34*!4' &$ BKL*4( 4.* ',+#*'/ .&!8!4'4!.*$/ -'%' ('4$%,' /

    /$*4!,,' &$ %$',!7'% S$ #3!,!7' #* -#*3. &$ /#3#%' &$ '3$%!', /!*33!4. %$'/.%!,$

    "#$ $/ &'&. -.% $*4!' &$, ,#+'% &.*&$ /$ %$8,$)' $, -$%!3.*$. $/!4',9 ' *!$, &$

    ,./ .%&$/ &$ ,' !*4!/!* #3$%!*' $* $, /$+$*3. !*8$%!.% . &.*&$ /$ $*4.*3%'%'

    $/3' !*4!/!* /! ,' '3.*' 8#$/$ -./3$%!.% ' #* -'%3. '+!*', S$ -'/' $, -#*3.

    &$/&$ '&$,'*3$ ('4!' '3%/ ,#$+. $/ '*#&'&. ' *!$, '*3$%.K/#-$%!.% C$%4'*. '

    $/3$ -#*3. /$ %$',!7' .3%. "#$ $/ '*#&'&. &$ ,' !/' '*$%'9 /$ %$-!3$ $/3$

    -%.4$&!!$*3. &$, .3%. ,'&.9 "#$&'*&. '/ 4#'3%. -#*3./ 4.-%$/!./ #3$%!*./

    =

  • 8/17/2019 TESIS 21 FIN 2.docx

    51/78

    M!$*3%'/ /$ %$',!7' $/3' 34*!4'9 ', !+#', "#$ $* ,' 34*!4' &$ BKL*4(9 /$ *$4$/!3'

    #* '#&'*3$ "#$ 4.-%!' $, 3$%.

    C D$/'/4#,'%!7'4!* #3$%!*' -%.+%$/!'

     A&R'. &$/4%!$ ,' ,!+'%' /#4$/!' &$ ,./ '/./ "#$ !%%!+'* $, 3$%. -'%'4.*/$+#!% 4.*3%.,'% $, /'*+%'&. #3$%!*. A,+#*./ /./3!$*$* "#$ ,' ,!+'%' -'/. '

    -'/. &$ ,./ '/./ "#$ !%%!+'* $, 3$%. 4.*3%.,' $, /'*+%'&. $* ,./ -'/./ !*!4!',$/

    ,.+%'*&. '/ #*' 34*!4' / /$*4!,,' $*.% 3!$-. "#!%%+!4. L./ -'/./ /.* 5:1 L!+'%' #*!,'3$%', &$ ,' '%3$%!' #3$%!*' $* #* /$43.% ',3. &$ ,' !*4!/!* #3$%!*'2 L!+'%' &$ ,' '%3$%!' #3$%!*' 4.*3%','3$%', ', !/. *!$, "#$ $, -%!$% -'/.? L!+'%' #*!,'3$%', &$ ,' '%3$%!' #3$%!*' ?K5 4 &$'). &$ &.*&$ /$ %$',!7 ,'

    -%!$% ,!+'%' L!+'%' &$ ,' '%3$%!' #3$%!*' 4.*3%','3$%', ', !/. *!$, "#$ $, -'/. ?5 L!+'%' !,'3$%', &$ ,'/ '%3$%!'/ .%!4'/E* 10 ', 15 &$ ,./ 4'/./ &$ '3.*' #3$%!*'9 $/ /#8!4!$*3$ ,' ,!+'%' #*!,'3$%', &$

    ,' '%3$%!' #3$%!*' -'%' 4.*3%.,'% ,' ($.%%'+!'Q ,' ,!+'%' !,'3$%', 4.*3%.,'% #* ;5

    '&!4!.*', &$ $/3./ 4'/./

    D H!/3$%$43.!'L' (!/3$%$43.' /#3.3', (' /!&. '4.*/$)'&' -'%' %$!% ,./ 3!$-./ "#!%%+!4./

    ,' -%&!&' /'*+#*$' D$)'% $, 4#$,,. '-'%$4$ 4.. #*' #$*' .-4!* 4#'*&. $,

    /'*+%'&. ' $/3 4.*3%.,'&. ,./ 3!$-./ "#!%%+!4./ ,' -%&!&' /'*+#*$' ('*

    /!&. !-.%3'*3$/ L' $*3')' &$ ,' (!/3$%$43.' $/ 3%'3'% &!%$43'$*3$ $, .%!+$*

    &$, /'*+%'&. -$%. ,' &$/$*3')' $/ ,' $3%'44!* &$, 3$%. $* #*' -'4!$*3$ 4.*

    &$/$./ &$ 8$%3!,!&'&L' (!/3$%$43.' -./3-'%3. -#$&$ /$% 3.3', . /#3.3', S! (' /'*+%'&.

    !*4.*3%.,',$ ,#$+. &$ #* -'%3. '+!*', ,' $,.4!&'& $/ $/$*4!', E/ ,' .&',!&'& &$

    3%'3'!$*3. "#!%%+!4. / #3!,!7'&' $* ,' HPP '/!' D$!&. ' "#$ $/3$

    -%.4$&!!$*3. /$ %$',!7' ('!3#',$*3$ 4.* /'*+%'&. '43!.9 $/ !-.%3'*3$

    4,'-$'%9 /$44!.*'% ,!+'% %-!&'$*3$ ,./ -$&4#,./ &$'). &$, *!$, &$ ,'/

    50

  • 8/17/2019 TESIS 21 FIN 2.docx

    52/78

    '%3$%!'/ #3$%!*'/ P'%' $!3'% &''% ,./ #%3$%$/9 ,'/ '%3$%!'/ #3$%!*'/ &$$%'* /$% 

    ,!+'&'/ *. # 4$%4' &$, /$+$*3. #3$%!*. !*8$%!.% ,#$+. %$',!7'% /#4$/!'/

    -$"#$'/ 3.'/9 #*' &$*3%. &$ ,' .3%'9 $* $, $/-$/.% &$, ,!+'$*3. 4'%&!*', $,

    3$%./'4%.D$!&. ' "#$ -#$&$ /$% &!8!4#,3./' ,' -',-'4!* &$, 4#$,,. #3$%!*.9 $/ -%$8$%!,$

    '%!% ,' '+!*' ,#$+. 4!%4#*/4%!!% $, 4#$,,. #3$%!*. S$ '4.*/$)' ('!3#',$*3$

    '/$+#%'% ,./ *+#,./ '+!*',$/ 4.* #*' /#3#%' $* 8.%' &$ `.4(.` ,#$+. 4$%%'% 

    ,./ .%&$/ '+!*',$/E/ # '4.*/$)',$ /$% +$*$%./. $* ,' 4.,.4'4!* !*3%'.-$%'3.%!' &$ &%$*')$/

    '&.!*',$/ -'%' 4.*3%., &$ -./!,$/ ($.%%'+!'/ -./3.-$%'3.%!'/

    211KCONSECUENCIAS SECUELAS DE HEMORRAGIA POSTPARTOL'/ 4.*/$4#$*4!'/ &$ ,' HPP /.* $, 4(."#$ 9*$4$/!&'& &$ 3%'*/8#/!.*$/ /#/

    %!$/+./ 9!*8$44!.*$/ 4.*4.!3'*3$/ 9'*$!' 9&!8!4#,3'& $* ,' ,'43'*4!' 4..

    /$4#$,'/ -'*(!-.-!3#!3'%!/. . /*&%.$ &$ S($$('* 9-%.,$'/ &$ 8$%3!,!&'&

    CAPITULO II METODOLOGIA APLICADA

    1KMETODO

    E, -%$/$*3$ 3%''). 4.%%$/-.*&$ ' #* $/3#&!. &$ 3!-. -%./-$43!. ,.*+!3#&!*',

    &$/4%!-3!.

    2KDISEbO DE INVESTIGACION

    S$ 3%'3' &$ #* $/3#&!. *. $-$%!$*3',

    51

  • 8/17/2019 TESIS 21 FIN 2.docx

    53/78

    ?KUNIVERSO O POBLACION

    E, #*!$%/. ,. 4.*/3!3#$* 61< #)$%$/ +$/3'*3$/ -#%-$%'/ !*$&!'3'/

    '3$*&!&'/ $* $, &$-'%3'$*3. &$ G!*$4.K./3$3%!4!' &$, (./-!3', C'%,./ M.*+$M$&%'*.KJ#,!'4' %'*3$ $, -$%!.&. 01 &$ '+./3. – 01 &$ *.!$%$ 2015 9

    KMUESTRA

    L' #$/3%' $/3 4.*/3!3#!&' -.% ?= #)$%$/ '3$*&!&'/ $* $, &$-'%3'$*3. &$

    G!*$4.K ./3$3%!4!' &$, (./-!3', C'%,./ M.*+$ M$&%'*. $* $, -$%!.&. &$ 01 &$

    '+./3. ' 01 &$ *.!$%$ &$ 2015 "#$ 4#-,$* ,./ 4%!3$%!./ &$ !*4,#/!*

    CRITERIOS DE INCLUSION:

    KP#%-$%'/ !*$&!'3'/ "#$ 3#!$%.* ($.%%'+!' -./3-'%3. -%$4.7 &$*3%. &$ ,'/

    -%!$%'/ 2 (.%'/ 4.*/$4#3!'/ ', -'%3.

    KP'4!$*3$/ 4.* -'%3. !*/3!3#4!.*',9 -'%3. &.!4!,!'%!. . -'%3. $* 3%*/!3.

    KP'4!$*3$/ 4.* -'%3. -.% ' '+!*', -.% 4$/%$'

    CRITERIOS DE E@CLUSION:

    KP'4!$*3$/ "#$ *. (!4!$%.* ($.%%'+!' -./3-'%3. -%$4.7

    K-'4!$*3$/ "#$ (!4!$%.* ($.%%'+!' -./3-'%3. 3'%&'

    5KTECNICA DE RECOLECCION DE DATOS

    52

  • 8/17/2019 TESIS 21 FIN 2.docx

    54/78

    S$ %$',!7 ,' %$4.,$44!* &$ &'3./ ,,$*'*&. ,' 8!4(' &$ %$4.,$44!* &$ &'3./ ',

    $*3%$!/3'% ' ,'/ -'4!$*3$/ ', %$!/'% ,'/ (!/3.%!'/ 4,*!4'/ $* $, &$-'%3'$*3. &$

    +!*$4.K./3$3%!4!' &$, (./-!3', C'%,./ M.*+$ M$&%'*. &$ ,' 4!#&'& &$ J#,!'4' $*

    /#' /$ #/ 8#$*3$/ -%!'%!'/ /$4#*&'%!'/

    6KPROCESAMIENTO ANALISIS DE INFORMACION:

    S$ 3.' !*8.%'4!* %$,$'*3$ ', $/3#&!. &$ !*$/3!+'4!* /$+#!&. &$ 4.*3%., &$

    4',!&'& -'%' ,#$+. #/'% ,./ %$4#%/./ &$ 3'#,'4!* %$-%$/$*3'4!* $* +%8!4./

    -'%' /# $).% !*3$%-%$3'4!*

    P'%' ,' 4#'*3!8!4'4!* &$, /'*+%'&. +$*!3', /$ #/ '&$/ $, '-.. &$ .3%./

    -'%$3%./ 4.. ,'/ 8#*4!.*$/ !3',$/ "#$ $/3* $/3!-#,'&'/ $* ,' 4,'/!8!4'4!* &$

    ($.%%'+!'9 -.% .3%. ,'&. /$ #/ ,' ($.+,.!*' &!8$%$*4!', '*3$/ &$/-#/ &$,

    -'%3.

     AMBITO GEOGRAFICO

    E, &!/3%!3. &$ J#,!'4' $/3' #!4'&' $* ,' -'%3$ *.%3$ &$ ,' -%.!*4!' &$ S'* R.'*

    &$, &$-'%3'$*3. &$ P#*.9 &$ *#$/3%. -'/ P$%99,' 4'-!3', &!/3%!3', /$ $*4#$*3%' '

    ?

  • 8/17/2019 TESIS 21 FIN 2.docx

    55/78

    E, (./-!3', C'%,./ M.*+$ M$&%'*. '3!$*&$ '&$/ &$ ,' -%.!*4!' S'* R.* '

    %$8$%$*4!'/ -%.$*!$*3$/ &$ ,'/ -%.!*4!'/ &$ S'*&' 9C'%'''9 H#'*4'*9

     A7*+'%.9 L'-' M$,+'%

     

    ;KOPERACIONALIZACION DE VARIABLES

    VARIABLES INDICADOR VALOR ESCALA DE

    MEDICIONDEPENDIENTE:H$.%%'+!'

    -./3-'%3.

    P$%&!&'

    /'*+#*$' 3%'/

    -'%3. '+!*', .

    4$/'%$'

     

    500 44 .

    100044

    C.$8!4!$*3$/ .

    %'7.*$/

    INDEPENDIENTES:$&'& N &$ './ &$

    !&'

    X1< '

    1=K? '

    ?5K?= '

    0 '

    C.$8!4!$*3$/ .

    %'7.*$/

    G%'&. &$ !*/3%#44!.* E'4!*

    %$4!!&'

     A*',8'$3'

    P%!'%!'

    S$4#*&'%!'

    /#-$%!.% 

    O%&!*',

    5

  • 8/17/2019 TESIS 21 FIN 2.docx

    56/78

    -%.4$&$*4!' L#+'% &$ &.*&$

    !$*$

    Z.*' #%'*'

    Z.*' %#%',

    *.!*',

    N!$,

    /.4!.$4.*.!4.

    E/3'3#/

    $4.*!4. "#$

    /'3!/8'+'

    *$4$/!&'&$/

    B').

    R$+#,'% 

    ',3.

    *.!*',

    P$/. ', !*!4!. &$

    $'%'7.

    P$/. &$ ,'

    '&%$ ', !*!4!.

    &$ +$/3'4!*

    D$,+'&$7 IMCX1

  • 8/17/2019 TESIS 21 FIN 2.docx

    57/78

    INDEPENDIENTES MEDICIONE&'& +$/3'4!.*', N &$ /$'*'/

    &$ +$/3'4!.*

    D$ 22 ' ?6/$

    D$ ?; ' 2 /$

    2 /$

    C.$8!4!$*3$/ .

    %'7.*$/

    L#+'% &$ '3$*4!*

    &$, -'%3.

    L#+'% &.*&$ /$

    -%.$

    $-#,/!* &$, RN

    -,'4$*3'

    P'%3. &.!4!,!'%!.

    P'%3. $* 3%'*/!3.

    P'%3. !*/3!3#4!.*',

    N.!*',

    N &$ -%.+./ &$,

    $'%'7.

    N#$%. &$ 8$3./ /!-,$

     #,3!-,$

    N.!*',

    M'*$). &$,',#%'!$*3.

     A3$*4!* &$$-#,/!* &$ ,'

    -,'4$*3'

    E/-.*3'*$.'43!.

    N.!*',

    P$/. &$, %$4!*

    *'4!&.

    P$/. &$,

    -%.+. ',

    *'4$% 

    M# '). -$/. *'4$%

    X 1500+

    B'). -$/. ', *'4$%

    X2500+ A&$4#'&. 2500K

    ?500

    G%'*&$?500K000+

    M'4%./.!'000+

    N.!*',

    C'*3 &$ ,!"#!&.

    '*!.3!4.

    *&!4$ &$ ,!"#!&.

    '*!.3!4.

    O,!+.'*!./ ILAX5

     A&$4#'&. ILA 5K25P.,!'*!./ ILA25

    N.!*',

    D#%'4!* &$, 3%'').

    &$ -'%3.

    T!$-. &$

    %'4!* &$,

    3%''). &$ -'%3.

    K-%$4!-!3'&. X?(

    KA&$4#'&.

    -%.,.*+'&.12(

    N.!*',

    56

  • 8/17/2019 TESIS 21 FIN 2.docx

    58/78

    !3. 8$3', M#$%3$ &$ 8$3.

    !*3%'#3$%.

    /!

    *.

    *.!*',

    V'%!',$/

    !*&$-$*&!$*3$/

    !*&!4'&.% V',.% E/4',' &$

    $&!4!* A*3$4$&$*3$ &$

    ,$+%'&. #3$%!*.

    P%.4$& "#!%%+!4.

    &$ $'4#'4!*

    4#%$3')$ &$

    $*&.$3%!.

    N.

    S! '.%3.

    !*4.-,$3. .

    %$3$*4!* &$

    $%'*'/

    N.!*',

    H!/3.%!' &$ HPP A*3 &$ HPP $*

    '*3$%!.% $'%'7.

    S!

    *.

    N.!*',

    P'3.,.+'/

    4'#/'*3$/ &$

    I*)#%!' '/4#,'% 

    P#$&$* %.-$%

    '/./ &$ &$4!'

    '/',

    P%$$4,'-/!'

    D!'$3$/ $,,!3#/

    E*8 %$*', 4%*!4'

    N.!*',

    D$/-%$*&!!$*3.

    -%$'3#%. &$

    -,'4$*3'

    D$/-%$*&!!$*3.

    &$ -,'4$*3'

    !*/$%3'&' $* /!3!.

    *.%',

    S!

    *.

    N.!*',

    P,'4$*3' -%$!'

    3.3',

    I*/$%4!* &$

    -,'4$*3' $*

    /$+$*3. !*8$%!.% 

    S!

    *.

    N.!*',

    4.%!.'*!.*!3!/ I*8$44!* &$

    4'!&'& '*!3!4'

    '*$./

    S!

    *.

    N.!*',

     T#.%$/ $* 4'*', M'/'/ $* 4'*', S! N.!*',

    5;

  • 8/17/2019 TESIS 21 FIN 2.docx

    59/78

    &$, -'%3. &$, -'%3. *.

    CAPITULO III ANALISIS E INTERPRETACION DE RESULTADOS

    1K RESULTADOS DE LA INVESTIGACION

    INCIDENCIA ABSOLUTA:

    S$ %$+!/3%'%.* ?= 4'/./ *#$./ &$ ($.%%'+!' -./3-'%3. -%$4.7 $* $, (./-!3',

    C'%,./ M.*+$ M$&%'*. –J#,!'4' 9$* $, -$%!.&. &$ 3!$-. 01 &$ '+./3. K01 &$

    *.!$%$ &$ 2015

    PROPORCION DE INCIDENCIA PI:

    S!$*&.:

    N: *#$%. &$ 4'/./ *#$./ U: -.,'4!* $-#$/3' PI:NU

    5

  • 8/17/2019 TESIS 21 FIN 2.docx

    60/78

    L' -%.'!,!&'& 4.* ,' "#$ '-'%$4$ ,' ($.%%'+!' -./3-'%3. -%$4.7 $* $, -$%!.&.

    01 &$ '+./3. K01 &$ *.!$%$ 2015

    PI:?=61< 69?1

    TASA DE INCIDENCIA O DENSIDAD DE INCIDENCIA TI:

    S!$*&. :

    N:*#$%. &$ 4'/./ *#$./ U:-.,'4!* $-#$/3'

    T:3!$-. &$ $-./!4!* TI:NUT

    TI:?=61< 025 '. 0252 4'/./ '. E/ &$4!% 25 #)$%$/ -.% 100 '.

    T',' 1 4'%'43$%!/3!4'/ /.4!.&$.+%8!4'/ &$ ,'/ -'4!$*3$/ '3$*&!&'/ $* $,

    (./-!3', CMMKJ#,!'4' E* $, -$%!.&. 01 &$ '+./3.K01 &$ *.!$%$ 2015

    V'%!',$ N &$ 4'/./ P.%4$*3')$ 1KEDADX1< ' 2 059121=K? ' 26 66966?5K?= ' = 2?90;0 ' 2 05912

      3.3', ?= 100

    2KGRADO DE

    INSTRUCCION A*',8'$3' 0 0

    P%!'%!' 10925S$4#*&'%!' ??

  • 8/17/2019 TESIS 21 FIN 2.docx

    61/78

    Z.*' #%'*' ?

  • 8/17/2019 TESIS 21 FIN 2.docx

    62/78

    T',' 2: '*3$4$&$*3$/ +!*$4.K./33%!4./ &$ -'4!$*3$/ '3$*&!&'/ $* $, (./-!3',

    C'%,./ M.*+$ M$&%'*. $* -$%!.&. 01 &$ '+./3.K01 &$ *.!$%$ 2015

    '%!',$/ N &$ 4'/./ P.%4$*3')$1KPARIDAD*#,!-'%' 5 129

  • 8/17/2019 TESIS 21 FIN 2.docx

    63/78

    0 109251K 20 5192<5K10 15 ?

  • 8/17/2019 TESIS 21 FIN 2.docx

    64/78

    DEL PARTOP'%3. &.!4!,!'%!. 6 159?<P'%3. $* 3%'*/!3. ? 0;96=P'%3. !*/3!3#4!.*', ?0 1? $* 4$*3%. &$

    /',#&

      1 $* (./-!3',

    ;69=2

      T.3', ?= 100

    2KVIA DEL PARTO

    V'+!*', ?2

  • 8/17/2019 TESIS 21 FIN 2.docx

    65/78

    G%'*&$ 2 05912

    M'4%./.!4. 0 0

      T.3', ?= 100

    6KPATOLOGIA cUE

    CAUSA INJURIA

    VASCULAR

    N &$ 4'/./ -.%4$*3')$

    P%$$4,'-/!' /$$%' ? 0;96=D!'$3$/ $,,!3#/ 0 0E*8$%$&'& %$*', 0 0

    N!*+#*' ?6 =29?0

      T.3', ?= 100

    ;KDESPRENDIMIENTOPREMATURO DE

    PLACENTAS! ? 0;96=N. ?6 =29?0  T.3', ?= 100

  • 8/17/2019 TESIS 21 FIN 2.docx

    66/78

    T',' 5 KHPP -%$4.7 -.% %$3$*4!* &$ -,'4$*3'9 %$/3./ -,'4$*3'%!./ $%'*'/

    .#,'%$/ $* (./-!3', C'%,./ M.*+$ M$&%'*. &$ 1 &$ '+./3.K1 &$ *.!$%$ 2016

    V'%!',$/ N &$ 4'/./ P.%4$*3')$

    R$3$*4!* &$ -,'4$*3'

    %$/3./

    P,'4$*3'%!./

    1 50

    R$3$*4!* %$/3./

    -,'4$*3'%!./

    $%'*'/

    4.%!.'*!.3!4'/

    1 50

      T.3', 2< 100

    T',' 6K HPP -%$4.7 -.% ,$/!* &$, 4'*', &$, -'%3. $* (./-!3', C'%,./ M.*+$

    M$&%'*. &$ 01 &$ '+./3.K01 &$ *.!$%$ &$ 2015

    V'%!',$ N &$ 4'/./ P.%4$*3')$

    D$/+'%%. &$ 4%! 2 25D$/+'%%. &$ '+!*' ? ?;95

    65

  • 8/17/2019 TESIS 21 FIN 2.docx

    67/78

    D$/+'%%. &$ -$%!*$ 2 25D$/+'%%. &$ 4%!

    '+!*'

    1 1295

      T.3', < 100

    T',' ;K4'#/'/ &$ HPP -%$4.7 $* $, /$%!4!. &$ +!*$4../3$3%!4!' &$, (./-!3',

    CMM $* $, -$%!.&. 01 &$ '+./3. K01 &$ *.!$%$ 2015

    C'#/'/ &$ HPP -%$4.7 N &$ 4'/./ P.%4$*3')$

    R$3$*4!* &$ -,'4$*3'

    %$/3./

    22 5691

    D$/+'%%. &$ 4'*', &$,

    -'%3.

    1 02956

    R$3$*4!* &$ -,'4$*3'

    %$/3./

    [&$/+'%%. &$ 4'*', -'%3. 6 159?<

     A3.*' #3$%!*' = 2?90; A3.*' #3$%!*' [&$/+'%%. &$ 4'*', &$

    -'%3.

    1 02956

     A,3$%'4!* &$ 4.'+#,'4!* 0 0

    3.3', ?= 100

    66

  • 8/17/2019 TESIS 21 FIN 2.docx

    68/78

    6;

  • 8/17/2019 TESIS 21 FIN 2.docx

    69/78

    6

  • 8/17/2019 TESIS 21 FIN 2.docx

    70/78

    2KCONCLUSIONES

    KD$*3%. &$ ,'/ 4'%'43$%/3!4'/ /.4!.&$.+%8!4'/ 3$*$./ -'4!$*3$/ $* /#

    '.%' )$*$/ 9,$ /!+#$ +$/3'*3$/ './'/ 4.* 2?90; "#$ 4.*/3!3#$ 8'43.% &$

    %!$/+. &$ ($.%%'+!' -./3-'%3. 9-.% .3%. ,'&. $, *!$, /.4!.$4.*!4. %$+#,'% 

    -%$&.!*' 4.* ;=9< 9$* /$+#*&. ,#+'% *!$, '). 4.* #* 20951 "#$

    +$*$%',$*3$ -./3$%+' ,' /'3!/8'44!* &$ ,'/ *$4$/!&'&$/ &$ /',#& 9 ,. 4#',

    4.*,,$' ' 3$*$% 4.-,!4'4!.*$/ $* $'%'7.9 '&$/ 4'$ %$/',3'% "#$ *. ('

    4'/./ &$ *!$, /.4!.$4.*!4. ',3. $* ,' #$/3%' &$ $/3#&!.

    KE* $, $/3#&!. %$',!7'&. /$ -%$/$*3' $, -$/. ', !*!4!. &$ +$/3'4!* #* -.%4$*3')$ &$

    2956 -'%' ,' &$,+'&$79 $, !/. -.%4$*3')$ -'%' .$/!&'&9 './ $3%$./ /.*

    -'3.,+!4./ -'%' $, $'%'7.9 $, %$/3. /$ -#$&$ 4.*/!&$%'% -$/. '&$4#'&. -'%' ,'

    3',,' /$+* $, *&!4$ &$ '/' 4.%-.%',

    KE* 4#'*3. ' ,' '*$!' $* $, 3$%4$% 3%!$/3%$ &$ +$/3'4!* /$ &$#$/3%' "#$ 4'/!#* ? 4#%/' 4.* #* +%'&. &$ '*$!'9 #* 2?90; &$ '*$!' ,$$9 ;96< &$

    '*$!' .&$%'&'9 #* 2956 &$ '*$!' /$$%'9 '&$/ $/3 $, ($4(. &$ "#$

    -'4!$*3$/ "#$ 3#!$%.* #*' ($.+,.!*' &$*3%. &$ -'%$3%./ *.%',$/ &$/-#/

    &$ ,' ($.%%'+!' -./3-'%3. '43#', /$ 8#$%.* &$ ',3' 4.* '*$!' &$ .&$%'&' '

    /$$%'

    KE, 4.*3%., -%$*'3', &$ ,' +$/3'*3$ 8#$ #*. &$ ,./ -#*3./ $* /# '.%'

    &$/4#!&'&./ -#$/3. "#$ 8#$ *#,. $* #* 109259 &$8!4!$*3$ $*./ &$ $* #*

    51926 9 /.,. #* ?< 96 8#$ '4$-3',$ '4$%4*&./$ ' 10 CPN

    6=

  • 8/17/2019 TESIS 21 FIN 2.docx

    71/78

    KS$ $*4#$*3%' "#$ $, -'%3. -%$3%!*. $/ 8%$4#$*3$ 4.* #* ?09;6 $/. !-,!4' '

    /# $7 "#$ (#. %$3$*4!* &$ %$/3./ -,'4$*3'%!./ $%'*'/ &.*&$ /$ 3#. "#$

    %$',!7'% %$!/!* &$ 4'!&'& #3$%!*'

    KE, ,#+'% &$ '3$*4!* &$, -'%3. -%$/$*3' #* 159?< &$ -'%3. &.!4!,!'%!.9 &.*&$ /$

    $*3!$*&$ "#$ $, '*$). &$, ',#%'!$*3. 8#$ $/-.*3'*$.9 -.% #* 8'!,!'%9

    '4#&$* ', (./-!3', -.% %$3$*4!* &$ -,'4$*3' . /'*+%'&. +$*!3',9 $, -'%3. $*

    3%*/!3. ',4'*7. #* ;96= ,. 4.*/3!3#$* %$8$%$*4!'/ &$ ,.4',!&'&$/ &$ -%.!*4!'/

    ',$)'&'/ 4.. S'*&!' $* $/$ 3%'$43. 3'-.4. (#. '*$). '43!. &$,

    ',#%'!$*3. -'%' '#&'% ' -%$$*!% ,' ($.%%'+!' -./3-'%3.

    KE* ,' #$/3%' &$ $/3#&!. /$ -%$/$*3' ,' -%$$4,'-/!' /$$%' $* #* ;96= "#$

    8#$%.* /.$3!&'/ ' 4$/%$'

    KE* ,' #$/3%' &$ ,'/ ?= -'4!$*3$/ 4.* ($.%%'+!' -./3-'%3. -%$4.7 910

    -%$/$*3'%.* ($.%%'+!' /$$%' 4.* #*' ($.+,.!*' &!8$%$*4!', '.% &$

    +&, 9"#$ %$"#$%'* 3%'*/8#/!* &$ -'"#$3$ +,.#,'% -$%. /.,. %$4!!$%.* #*'

    #*!&'& &$ /'*+%$

    KC'$ *.3'% "#$ ,' 4'#/' / 8%$4#$*3$ &$ ($.%%'+!' -./3-'%3. $*4.*3%'&' $* ,'

    #$/3%' &$ $/3#&!. *. 8#$ ,' '3.*' #3$%!*' /!*. (#. #* 4'/! #* ;2 &$ %$3$*4!*

    &$ -,'4$*3' 9 %$/3./ -,'4$*3'%!./ $%'*'/ .#,'%$/ -%.',$$*3$ -.% 

    '4%$3!/. -,'4$*3'%!.9 ,#$+. ,' '3.*' #3$%!*' 8#$ &!'+*./3!4'&' $* #* 2596? 9

    /$+#!&. &$ &$/+'%%. &$, 4'*', &$, -'%3. 4.* #* 21 ,' ',3$%'4!* &$ 4.'+#,'4!*

    *. /$ &$/4%!$

    ;0

  • 8/17/2019 TESIS 21 FIN 2.docx

    72/78

    ?KRECOMENDACIONES

    KC..%&!*'4!* $*3%$ $, -$%/.*', &$ /',#& &$, $/3',$4!!$*3. &$ /',#& ,'

    4.#*!&'& .%+'*!7'&' -'%' /#'% $/8#$%7./

    KS$+#!!$*3. -.% -'%3$ &$, -$%/.*', &$ /',#& $* $, 4.*3%., -%$*'3', &$ +$/3'*3$/

    -'%' !&$*3!8!4'% ,' -.,'4!* &$ %!$/+. ./33%!4.

    KB%!*&'% 4'-'4!3'4!* ' ,'/ '&%$/ +$/3'*3$/ '/ $*/$'%,$/ ' %$4.*.4$% /!+*./

    /*3.'/ &$ ','%' -'%' ($.%%'+!' -./3-'%3.

    KS$ &$$ &'% 4.*/$). *#3%!4!.*', -'%' #*' ',!$*3'4!* $8!4'79 4.*/$+#!% &!/!*#!% 

    . &$/'-'%$4$% ,' '*$!' $* ,' +$/3'*3$

      FICHA DE RECOLECCION DE DATOS

    SEDE :HOSPITAL CARLOS MONGE MEDRANOKJULIACA HC:>>>>>>

    DATOS DE FILIACION:

    ;1

  • 8/17/2019 TESIS 21 FIN 2.docx

    73/78

    N.%$ :>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    E&'&: >>>>> F$4(' &$ *'4!!$*3.:>>>>>>

    L#+'% &$ *'4!!$*3.>>>>>>>>>>>> L#+'% &$ %$/!&$*4!':>>>>>>>

    I&!.':>>>>>>>>>>>>>>>>>

    %$,!+!*:>>>>>>>>

    G%'&. &$ !*/3%#44!*:>>>>>>>>>>>>>

    O4#-'4!*:>>>>>>>>>>>>>>>>E/3'&. 4!!,:>>>>>>>>>>>>>

    DATOS GINECOOBSTETRICOS:

    M$*'%"#!':>>>>>>>>>>>>>> R+!$* 4'3'$*!',:>>>>>>>>>

    F.%#,' ./33%!4' >>>>>>>>>> 8$4(' &$ '*3$%!.% -'%3.:>>>>>>>>

    P$/. '.% &$ %$4!* *'4!&. '*3$%!.%:>>>>>>>>>

     A*3$4$&$*3$/ &$ '.%3./:>>>>>>>>>>>>>>>>>>>>>>>>>>>>

     A*3$4$&$*3$/ &$ ($.%%'+!' -./3-'%3. '*3$%!.%:>>>>>>>>>>>>>>>>>>

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

     A*3$4$&$*3$/ -'3.,+!4./ &$ $'%'7./ '*3$%!.%$/:>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

     A*3$4$&$*3$/ &$ 3%'*/8#/!.*$/ /'*+#*$'/:>>>>>>>>>>>>>>>>>>>>

    EMBARAZO ACTUAL:

    FUR:>>>>>>>> -$/.>>

    N ,#+'% &$ CPN:>>>>>>>>>>>>>>>>>>>>>>>>>

    L'.%'3.%!.:

    H:>>>>H4:>>>> G%#-. 8'43.% RH: >>>-,'"#$3'/:>>>>>>>>>

    N &$ /$'*'/ &$ +$/3'4!*:>>>>>>P%$/$*3'4!*>>>>>>>/!3#'4!*>>>>>>-./!4!.*>>>>>>>'43!3#&>>

    C#'&%. 4,*!4.:>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    F#*4!.*$/ !3',$/:

    -#,/.:>>>>>>>PA:>>>>>>>>>T:>>>>>> FR:>>>>>>>>>>

    ;2

  • 8/17/2019 TESIS 21 FIN 2.docx

    74/78

    PARTO

    P'%3. :>>>>>>>>>>>>>> >>>>>>>>>>>> F$4(' -'%3.:>>>>

    L#+'% &$ '3$*4!* &$, -'%3.:>>>>>>>>>>>>>>>>>>>>>>>>>>

    R$8$%!&. &$ :>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    TRABAJO DE PARTO

    D#%'4!.* &$, -$%!.&. &$ &!,'3'4!* :>>>>>>>>>>>>>>>>>>>>>>>>

    D#%'4!.* &$, -$%!.&. &$, $-#,/!.:>>>>>>>>>>>>>>>>>>>>>>>>

    D#%'4!* &$, -$%!.&. &$, ',#%'!$*3.:>>>>>>>>>>>>>>>>>>>>>

    M'*$). &$, ',#%'!$*3. :

    P,'4$*3' :>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    R$4!* *'4!&. : >>>>>>>> -$/. -'%' ,' $&'& +$/3'4!.*', >>>>>>>>>>

    D$/+'%%. :

    C$%!4',:>>>>>>>>> '+!*',:>>>>>>>>>>>-$%!*$',:>>>>>>>>>>>>>>>>>>>>>

    R$!/!* &$ 4'!&'&LU:(',,'7+./>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    C'*3!&'& &$ /'*+%'&. +$*!3',,:>>>>>>>>>>>>>>>>>>>>>>>>

    PUERPERIO INMEDIATO:

    F#*4!.*$/ !3',$/>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    C#'&%. 4,*!4.:>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    L'.%'3.%!. :

    H:>>>> H4:>>>>-,'"#$3'/ >>>>U%$':>>>>C%$'3!*!*':>>>>>>>>

    BIBLIOGRAFIA

    1KM!*!/3$%!. &$ /',#& G#' 34*!4' :G#' &$ -%43!4' 4,*!4' &$ -%.4$&!!$*3./

    $* ./3$3%!4!' -$%!*'3.,.+' 2010 R$/.,#4!* !*!/3$%!', N222005 !*/'

    P$%

    ;?

  • 8/17/2019 TESIS 21 FIN 2.docx

    75/78

    2KG#$%%$%. A B'%%$%' M C',,$ A D!'+*/3!4. '*$). &$ ,' ($.%%'+!'

    -./-'%3. R$!/3' P$%#'*' &$ G!*$4.,.+' O/3$3%!4!' 2010Q 5:2??K2?

    ?KC'%$%' SH$.%%'+!' P./-'%3.R$!/3' P$%#'*' &$ G!*$4.,.+!' 2010Q56:2K

    ?2

    KS',4$&. L F'!'*. P B.,'33! H d!*.+%'& R C.*/$*/. &$ '*$). &$ ,'

    ($.%%'+!' ./33%!4' 4%!3!4' 2010

    5KM$,. NG.$7 PT''%' LD$ G%'4!' JF'*$!3$ P#$* VU/. &$ !/.-%./3., $*

    ./3$3%!4!' +!*$4.,.+' FLASOGT$%4$%' $&!4!*201?=?K=6

    6K ENDES . A*',!/!/ &$ ,' /!3#'4!* &$ /',#& &$ P#*. 201?

    (33-:'*',!/!/ &$ /!3#'4!.* &$ /',#& -#*. /(3,e!77?BDD&

    ;K A/-%$' I L!-4(' D M'%4. LA*&!*' EC!,,. AL.#3. C R$4.$*&'4!.*$/

    -'%' ,' -%$$*4!*9 &!'+*/3!4. 3%'3'!$*3. &$ ,' H$.%%'+!' P./3K

    P'%3.A%+$*3!*' 201116K2<

  • 8/17/2019 TESIS 21 FIN 2.docx

    76/78

    11K G#!' &$ ($.%%'+!' -./-'%3. C.&!+. R.). C.,.!' 201 K1<

    12KT($ -%$$*3!.* '*& 3%$'3$*3 .8 -./3-'%3# ('$.%%('+$: ('3 &. $ *.9

    '*& ($%$ &. $ +. 3. *$3f R.', C.,,$+$ .8 O/3$3%!4!'*/ '*& G*'$4.,.+!/3/

    201:202K2101?KdHO %$4.$*&'3!.*/ 8.% 3($ -%$$*3!.* '*& 3%$'3$*3 .8 -./3-'%3#

    ('$.%%('+$ 3($ d.%,& H$',3( O%+'*!7'3!.* 20121KO!3.4!*' 8%$*3$ ' C'%$3.4!*' -'%' -%$$*!% ($.%%'+!'/ -./-'%3. 3%'/

    4$/%$' R$!/3' P$%#'*' &$ +!*$4.,.+' ./3$3%!4!' L!' 201V., 60 N 1

    15K C,'#&!. G S./' F A,3('$ J B$,!7* M B#$$*/ PF'43.%$/ &$ %!$/+. &$

    ($.%%'+!' -./3K-'%3. $* -'%3./ '+!*',$/ $* #*' -.,'4!* &$ A%!4' L'3!*'

    2006

    16K R$$/ OR!$/+. &$ ($.%%'+!' -./-'%3. $* ,' -'4!$*3$ +%'* #,3-'%' C,*!4'

    $ !*$/3!+'4!* $* +!*$4.,.+' ./3$3%!4!' 2011Q?

  • 8/17/2019 TESIS 21 FIN 2.docx

    77/78

    21KL$.* d V!,,''%!* SV$,'/4. SP%$$*4!.* 9&!'+*./3!4. 3%'3'!$*3. &$ ,'

    ($.%%'+!' -./-'%3. E4#'&.% 201?12K2?

    22KA',./ E A/-%$' LG'%4!' O G#!' -'%' ,' -%$$*4!*9&!'+*./3!4. 3%'3'!$*3.

    &$ ,' ($.%%'+!' -./-'%3. A%+$*3!*'2010

  • 8/17/2019 TESIS 21 FIN 2.docx

    78/78