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Vural T, Bayraktar B, Karaca SY, Golbasi C, Odabas O, Taner CE. Indications, risk factors, and outcomes of emergency peripartum hysterectomy: A 7-year retrospective study at a tertiary center in Turkey. Malawi Med J 2023; 35:31-42. [PMID: 38124696 PMCID: PMC10645903 DOI: 10.4314/mmj.v35i1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Objective To determine the incidence, indications, the risk factors, complications, maternal morbidity and mortality of emergency peripartum hysterectomy (EPH), and perinatal outcomes at a tertiary hospital, Turkey. Methods We analyzed 71 cases of EPH from 2012 to 2019 at a tertiary hospital in a retrospective study. There were 142 control patients. Results There were 71 EPH out of 69,504 deliveries, for an overall incidence of 1.02 per 1000 births. The main indication for peripartum hysterectomy was abnormal placentation (67.6%), followed by uterine atony (28.1%), and uterine rupture (4.2%). Cesarean section (CS) and previous CS are major risk indicators for EPH. Other risk indicators are advanced maternal age (≥ 35 years) and multiparity. All patients with abnormal placentation had a previous CS. 93% of EPH were performed during and/or after CS, and 7% after vaginal delivery. 69% of EPH were made in total and 31% were subtotal. The three most common maternal morbidity included: wound infection and febrile morbidity (26.7%), bladder injury (16.9%), and disseminated intravascular coagulopathy (11.2%). There were no maternal deaths but perinatal mortality was 4%. Conclusion The most common indication for EPH was abnormal placentation. Also, CS and previous CS are major risk factors of EPH. Other risk factors for EPH are advanced maternal age (≥ 35 years) and multiparity. Moreover, all unnecessary CS should be avoided.
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Affiliation(s)
- Tayfun Vural
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Suna Yildirim Karaca
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Ceren Golbasi
- Department of Obstetrics and Gynecology, Izmir Tinaztepe University Faculty of Medicine, Turkey
| | - Ozan Odabas
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Cuneyt Eftal Taner
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
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Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:35-48. [PMID: 36701608 DOI: 10.1097/aog.0000000000005022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings. DATA SOURCES PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021. METHODS OF STUDY SELECTION Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8,775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting. TABULATION, INTEGRATION, AND RESULTS The meta-analysis included 154 studies: 14,409 emergency peripartum hysterectomies were performed in 17,127,499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1,000 births (95% CI 1.0-1.3). The highest incidence was observed in lower middle-income settings (3/1,000 births, 95% CI 2.5-3.5), and the lowest incidence was observed in high-income settings (0.7/1,000 births, 95% CI 0.5-0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9-42.4), uterine atony (27.0%, 95% CI 24.6-29.5), and uterine rupture (21.2%, 95% CI 17.8-25.0). In lower middle-income countries, uterine rupture (44.5%, 95% CI 36.6-52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5-53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2,706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3-81.9). The most common complications were febrile (29.7%, 95% CI 25.4-34.3) and hematologic (27.5%, 95% CI 20.4-35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5-4.2) and was higher in lower middle-income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9-14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6-1.6). CONCLUSION Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.
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ELÇİ E, SAYAN S, ELÇİ G, ÇİM N. Perinatal outcome of patients with placenta percreata. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.768366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hussein AM, Kamel A, Elbarmelgy RA, Thabet MM, Elbarmelgy RM. Managing Placenta Accreta Spectrum Disorders (PAS) in Middle/Low-Resource Settings. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2019. [DOI: 10.1007/s13669-019-00263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sak S, Barut M, Incebiyik A, Uyanikoglu H, Hilali N, Sak M. Management of peripartum hysterectomies performed on patients with placenta percreta in a tertiary central hospital. J Matern Fetal Neonatal Med 2017; 32:883-888. [DOI: 10.1080/14767058.2017.1394289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sibel Sak
- Harran University School of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey
| | - Mert Barut
- Harran University School of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey
| | - Adnan Incebiyik
- Harran University School of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey
| | - Hacer Uyanikoglu
- Harran University School of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey
| | - Nese Hilali
- Harran University School of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey
| | - Muhammet Sak
- Harran University School of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey
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Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol 2017; 128:1281-1294. [PMID: 27824773 DOI: 10.1097/aog.0000000000001736] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy across income settings. DATA SOURCES PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases up to March 30, 2015. METHODS OF STUDY SELECTION Studies including emergency peripartum hysterectomies performed within 6 weeks postpartum. Not eligible were comments, case reports, elective hysterectomies for associated gynecologic conditions, studies with fewer than 10 inclusions, and those reporting only percentages published in languages other than English or before 1980. Interstudy heterogeneity was assessed by χ test for heterogeneity; a random-effects model was applied whenever I exceeded 25%. TABULATION, INTEGRATION, AND RESULTS One hundred twenty-eight studies were selected, including 7,858 women who underwent emergency peripartum hysterectomy, of whom 87% were multiparous. Hysterectomy complicated almost 1 per 1,000 deliveries (range 0.2-10.1). Prevalence differed between poorer (low and lower middle income) and richer (upper middle and high income) settings: 2.8 compared with 0.7 per 1,000 deliveries, respectively (relative risk 4.2, 95% confidence interval [CI] 4.0-4.5). Most common indications were placental pathology (38%), uterine atony (27%), and uterine rupture (26%). Risk indicators included cesarean delivery in the current pregnancy (odds ratio [OR] 11.38, 95% CI 9.28-13.97), previous cesarean delivery (OR 7.5, 95% CI 5.1-11.0), older age (mean difference 6.6 years between women in the case group and those in the control group, 95% CI 4.4-8.9), and higher parity (mean difference 1.4, 95% CI 0.7-2.2). Having attended antenatal care was protective (OR 0.12, 95% CI 0.06-0.25). Only 3% had accessed arterial embolization to prevent hysterectomy. Average blood loss was 3.7 L. Mortality was 5.2 per 100 hysterectomies (reported range 0-59.1) and higher in poorer settings: 11.9 compared with 2.5 per 100 hysterectomies (relative risk 4.8, 95% CI 3.9-5.9). CONCLUSION Emergency peripartum hysterectomy is associated with considerable morbidity and mortality and is more frequent in lower-income countries, where it contains a higher risk of mortality. A (previous) cesarean delivery is associated with a higher risk of emergency peripartum hysterectomy.
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Tahaoglu AE, Balsak D, Erdogdu E, Bakır MS, Aksin S, Bala M, Togrul C, Yalınkaya A. Bakri balloon placement effectively treats uterine atony and placenta previa. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1298467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Michelet D, Ricbourg A, Gosme C, Rossignol M, Schurando P, Barranger E, Mebazaa A, Gayat E. Emergency hysterectomy for life-threatening postpartum haemorrhage: Risk factors and psychological impact. ACTA ACUST UNITED AC 2015; 43:773-9. [PMID: 26597488 DOI: 10.1016/j.gyobfe.2015.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency postpartum hysterectomy (EPH) is usually considered the final resort for the management of postpartum hemorrhage (PPH). The aim of this observational study was to identify the risk factors for EPH, to evaluate the ability of EPH to stop bleeding and, finally, to estimate its psychological impact. METHODS This was a retrospective analysis of postpartum hysterectomy in all patients with PPH admitted between 2004 and 2011 to Lariboisière Hospital. We compared women for whom EPH was successful and those who required an advanced interventional procedure (AIP) to stop the bleeding despite hysterectomy. We also evaluated the severe PPH (SPPH) score in this particular setting. The psychological impact of emergency hysterectomy was also assessed. RESULTS A total of 44 hysterectomies were performed among 869 cases of PPH. Twenty were successful, while an additional AIP was required in 22 others (50%). Prothrombin time<50% and a shorter interval between the onset of PPH and hysterectomy were independently associated with the need for an additional AIP. The area under the ROC curve of the SPPH score to predict the need for another AIP was 0.738 (95% confidence interval 0.548-0.748). Furthermore, 64% of the hysterectomized patients suffered from post-traumatic stress disorder. CONCLUSION Failure of postpartum hysterectomy to control bleeding was frequent, and it was associated with persistence of coagulopathy. Hysterectomy in this context had important psychological impacts.
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Affiliation(s)
- D Michelet
- Department of Anesthesiology, Robert-Debré University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; University Paris Diderot, Paris, France
| | - A Ricbourg
- University Paris Diderot, Paris, France; Department of Obstetrics and Gynecology, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France
| | - C Gosme
- Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France
| | - M Rossignol
- University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France
| | - P Schurando
- University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France
| | - E Barranger
- University Paris Diderot, Paris, France; Department of Obstetrics and Gynecology, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France
| | - A Mebazaa
- University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; UMR-S 942, Inserm, 75010 Paris, France
| | - E Gayat
- University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; UMR-S 942, Inserm, 75010 Paris, France.
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Tahaoglu AE, Balsak D, Togrul C, Obut M, Tosun O, Cavus Y, Bademkiran H, Budak S. Emergency peripartum hysterectomy: our experience. Ir J Med Sci 2015; 185:833-838. [PMID: 26590053 DOI: 10.1007/s11845-015-1376-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the incidence of and reasons for emergency peripartum hysterectomy (EPH) between 2009 and 2013 in our hospital, one of the three hospitals with the highest rates of delivery in Turkey. METHODS A retrospective study. Seventy-six peripartum hysterectomies were evaluated. We compared the modes of delivery and examined whether bilateral internal iliac artery ligation was performed. RESULTS The incidence of EPH was 0.77 in 1000. The majority of cases involved multiparity, uterine rupture, placenta praevia, or placental invasion abnormalities. The most frequent reason for EPH was uterine atony (64.5 %). There was no statistically significant relationship with mode of delivery; however, the complication rate and requirement for fresh frozen plasma were significantly (p < 0.01) related to whether bilateral internal iliac artery ligation was performed. CONCLUSION Uterine atony was the most common indication for EPH. The most important step to avoid performing EPH is to calculate patients' risks for postpartum bleeding. Postpartum haemorrhage may not be preventable, but when it happens, obstetricians must be prepared to perform EPH, and in high-risk patients, to perform internal iliac artery ligation.
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Affiliation(s)
- A E Tahaoglu
- Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey.
| | - D Balsak
- Halic University, Istanbul, Turkey
| | | | - M Obut
- Diyarbakır Gynecology and Obstetrics Hospital, Diyarbakir, Turkey
| | - O Tosun
- Diyarbakır Gynecology and Obstetrics Hospital, Diyarbakir, Turkey
| | - Y Cavus
- Diyarbakır Gynecology and Obstetrics Hospital, Diyarbakir, Turkey
| | - H Bademkiran
- Diyarbakır Gynecology and Obstetrics Hospital, Diyarbakir, Turkey
| | - S Budak
- Diyarbakır Gynecology and Obstetrics Hospital, Diyarbakir, Turkey
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Ekin A, Gezer C, Solmaz U, Taner CE, Dogan A, Ozeren M. Predictors of severity in primary postpartum hemorrhage. Arch Gynecol Obstet 2015; 292:1247-54. [PMID: 26041324 DOI: 10.1007/s00404-015-3771-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/27/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH. METHODS Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses. RESULTS PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006). CONCLUSION Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.
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Affiliation(s)
- Atalay Ekin
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Cenk Gezer
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ulas Solmaz
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cuneyt Eftal Taner
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Askin Dogan
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Ozeren
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
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Senturk MB, Cakmak Y, Guraslan H, Dogan K. Emergency peripartum hysterectomy: 2-year experiences in non-tertiary center. Arch Gynecol Obstet 2015; 292:1019-25. [PMID: 25929233 DOI: 10.1007/s00404-015-3740-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate risk factors, indications and materno-fetal outcomes for emergency peripartum hysterectomy. METHODS Retrospective evaluation was made of 23 cases. Maternal and neonatal outcomes, need for referral to the tertiary center and related complications were compared to those at the initial diagnosis for surgery, location of delivery, type of surgery and the admission diagnosis. The risk factors associated with emergency peripartum hysterectomy were also investigated. Significance was evaluated at p values of <0.01 and <0.05. RESULTS There was a correlation between peripartum hysterectomy and uterine atony or uterine rupture (p < 0.01). The referral rates of patients with home delivery were significantly higher than those of patients who delivered in hospital (p = 0.02) but no significant difference was observed in the neonatal outcomes (p = 0.38). There was no significant difference in the rates of maternal complications between home and hospital delivery (p = 0.068). According to the indication for surgery, no significant difference was observed between the rates of referral to the tertiary center, maternal outcomes, complications, or need for maternal intensive care (p > 0.05). However, a highly significant difference was observed between the neonatal outcomes (p = 0.001). CONCLUSION The results of this study showed the most important risk factors associated with peripartum hysterectomy to be uterine atony, grand multiparity, and uterine rupture. Maternal intensive care, maternal death, neonatal death, or neonatal intensive care were associated with home delivery or delayed presentation at hospital.
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Affiliation(s)
- Mehmet B Senturk
- Departments of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
| | - Yusuf Cakmak
- Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey
| | - Hakan Guraslan
- Departments of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey
| | - Keziban Dogan
- Departments of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey
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Revisit of risk factors for major obstetric hemorrhage: insights from a large medical center. Arch Gynecol Obstet 2015; 292:819-28. [DOI: 10.1007/s00404-015-3725-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/13/2015] [Indexed: 11/25/2022]
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Eshkoli T, Weintraub AY, Baron J, Sheiner E. The significance of a uterine rupture in subsequent births. Arch Gynecol Obstet 2015; 292:799-803. [DOI: 10.1007/s00404-015-3715-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
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