1
|
Rajasingham M, Hossein Pour P, Scattolon S, Muraca GM. Temporal trends in peripartum hysterectomy among individuals with a previous cesarean delivery by race/ethnicity in the United States: A population-based cohort study. PLoS One 2024; 19:e0304777. [PMID: 38820511 PMCID: PMC11142665 DOI: 10.1371/journal.pone.0304777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/16/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVES Rates of severe maternal morbidity have highlighted persistent and growing racial disparities in the United States (US). We aimed to contrast temporal trends in peripartum hysterectomy by race/ethnicity and quantify the contribution of changes in maternal and obstetric factors to temporal variations in hysterectomy rates. METHODS We conducted a population-based, retrospective study of 5,739,569 US residents with a previous cesarean delivery, using National Vital Statistics System's Natality Files (2011-2021). Individuals were stratified by self-identified race/ethnicity and classified into four periods based on year of delivery. Temporal changes in hysterectomy rates were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). We used sequential logistic regression models to quantify the contribution of maternal and obstetric factors to temporal variations in hysterectomy rates. RESULTS Over the study period, the peripartum hysterectomy rate increased from 1.23 (2011-2013) to 1.44 (2019-2021) per 1,000 deliveries (OR 2019-2021 vs. 2011-2013 = 1.17, 95% CI 1.10 to 1.25). Hysterectomy rates varied by race/ethnicity with the highest rates among Native Hawaiian and Other Pacific Islander (NHOPI; 2.73 per 1,000 deliveries) and American Indian or Alaskan Native (AIAN; 2.67 per 1,000 deliveries) populations in 2019-2021. Unadjusted models showed a temporal increase in hysterectomy rates among AIAN (2011-2013 rate = 1.43 per 1,000 deliveries; OR 2019-2021 vs. 2011-2013 = 1.87, 95% CI 1.02 to 3.45) and White (2011-2013 rate = 1.13 per 1,000 deliveries; OR 2019-2021 vs. 2011-2013 = 1.21, 95% CI 1.11 to 1.33) populations. Adjustment ranged from having no effect among NHOPI individuals to explaining 14.0% of the observed 21.0% increase in hysterectomy rates among White individuals. CONCLUSION Nationally, racial disparities in peripartum hysterectomy are evident. Between 2011-2021, the rate of hysterectomy increased; however, this increase was confined to AIAN and White individuals.
Collapse
Affiliation(s)
- Maya Rajasingham
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Parnian Hossein Pour
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sarah Scattolon
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Giulia M. Muraca
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Solna, Karolinska Institutet, Eugeniahemmet, Clinical Epidemiology Unit, Stockholm, Sweden
| |
Collapse
|
2
|
Psenkova P, Tedla M, Minarcinova L, Zahumensky J. Application of a specific clinical pathway can affect the choice of trial of labor in patients with a history of cesarean delivery. BMC Pregnancy Childbirth 2024; 24:292. [PMID: 38641800 PMCID: PMC11027349 DOI: 10.1186/s12884-024-06429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/15/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Mode of delivery in women with previous history of cesarean delivery (CD) is highly modifiable by the practices of the delivery unit. Vaginal birth after a cesarean (VBAC) delivery is a safe and preferred alternative in most cases. The aim of this study was to assess the impact of adopting a complex set of measures aimed at the mode of delivery in this group. METHODS This was a retrospective observational study comparing two birth cohorts before and after the implementation of a series of quality improvement (QI) interventions. The study cohorts comprised women with a history of cesarean delivery who gave birth in the period before (January 2013 - December 2015) and after (January 2018 - December 2020) the adoption of the QI measures. The measures were focused on singleton term cephalic pregnancies with a low transverse incision in the uterus. Measures included approval of all planned CDs by a senior obstetrician, re-training staff on the use of the FIGO classification for intrapartum fetal cardiotocogram, establishing VBAC management guidelines, encouraging epidural analgesia during trial of labor after cesarean (TOLAC), establishing a labor ward team and introducing a monthly maternity audit. RESULTS Term singleton cephalic pregnancies with previous history of CD accounted for 12.55% of all births in the pre-intervention period and 12.01% in the post-intervention period. The frequency of cesarean deliveries decreased from 89.94% in the pre-intervention period to 64.47% in the post-intervention period (p < 0.0001). We observed a significant increase in TOLAC from 13.18 to 42.12% (p<0.0001) and also an increase in successful VBAC from 76.27 to 84.35% (p < 0.0001). All changes occurred without statistically significant change in overall perinatal mortality. CONCLUSIONS This study demonstrates the feasibility to safely increase trial of labor and vaginal birth after cesarean delivery by implementing a series of quality improvement interventions and clinical pathway changes.
Collapse
Affiliation(s)
- Petra Psenkova
- 2nd Department of Gynecology and Obstetrics, University Hospital Bratislava and Comenius University, Ruzinovska 6, Bratislava, 82106, Slovakia
| | - Miroslav Tedla
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Bratislava and Comenius University, Antolská 11, Bratislava, 851 07, Slovakia
| | - Lenka Minarcinova
- 2nd Department of Gynecology and Obstetrics, University Hospital Bratislava and Comenius University, Ruzinovska 6, Bratislava, 82106, Slovakia.
| | - Jozef Zahumensky
- 2nd Department of Gynecology and Obstetrics, University Hospital Bratislava and Comenius University, Ruzinovska 6, Bratislava, 82106, Slovakia
| |
Collapse
|
3
|
Ravi M, Singh MK, Kumar S, Singh S, Naik P. To Determine the Quality of Life in Indian Women After Peripartum Hysterectomy Using a Hindi Version of the SF-36 Questionnaire. J Obstet Gynaecol India 2024; 74:38-44. [PMID: 38434120 PMCID: PMC10902220 DOI: 10.1007/s13224-023-01812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/07/2023] [Indexed: 03/05/2024] Open
Abstract
Objective The objective of the study was to determine the quality of life in women after peripartum hysterectomy using a Hindi version of the SF-36 questionnaire. Background There are long-term effects on quality of life in women after peripartum hysterectomy. The effects on physical, mental, and social functioning have a prolonged recovery. No studies have been done in Indian women after peripartum hysterectomy to evaluate quality of life. Methods Patients who underwent peripartum hysterectomy from January 2017 to May 2021 were contacted to participate in the study. To determine the quality of life post-surgery, a Hindi version of the 36-item Short-Form Health Survey (SF-36) was used for a face-to-face personal interview-based assessment. The participants were divided into two groups based on the duration between surgery and the interview. The aggregate scores for the eight components of SF-36 were calculated, and responses were analyzed. Results Out of the 138 post-hysterectomy women, 118 were enrolled in the study. Women who could not be contacted [14 (10.14%)] and those who died post-procedure [6 (4.35%)] were excluded. Out of the total, 43 assessed participants were within 2 years of surgery, and 75 were after 2 years of surgery. The group that was assessed after 2 years of surgery had a significantly lower quality of life in six, out of the eight aspects of SF-36 domains. Conclusion Women after peripartum hysterectomy undergo a prolonged recovery phase with effects on physical, mental, and social functioning. A multi-disciplinary long-term follow-up including physiotherapy and psychotherapy is required and that should be guided by a dedicated clinical team.
Collapse
Affiliation(s)
- Monisha Ravi
- Department of Reproductive Medicine, Bangalore Baptist Hospital, Bangalore, 560024 India
| | - Mukesh Kumar Singh
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Sandeep Kumar
- Department of Paediatrics, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Sarita Singh
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Priyanka Naik
- Department of Obstetrics and Gynaecology, AIIMS, Ansari Nagar, New Delhi, India
| |
Collapse
|
4
|
Bayable M, Gudu W, Wondafrash M, Sium AF. Incidence, indications, and maternal outcomes of emergency peripartum hysterectomy at a tertiary hospital in Ethiopia: A retrospective review. Int J Gynaecol Obstet 2023; 161:279-282. [PMID: 36239219 DOI: 10.1002/ijgo.14510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the incidence, indications, and maternal outcomes of emergency peripartum hysterectomy (EPH) at a tertiary setting in Ethiopia. MATERIALS AND METHODS A 4-year retrospective review of EPH cases was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from January 2016 to December 2019. Data were collected by reviewing maternal charts of EPH cases using a structured data extraction format. Stata Statistical Software, release 14, was used for data analysis. Frequency and percentages are used to present the significance of results. RESULTS Among 39 629 deliveries during the study period, there were 105 EPH, making the incidence rate 2.6 per 1000 deliveries. The common indications for EPH were uterine rupture (63/105; 60%), intractable uterine atony (23/105; 21.9%), and placenta accreta spectrum (14/105; 14.7%). The most common complications were anemia (85/105; 80.9%), puerperal fever (13/105; 12.4%), acute kidney injury (10/105; 9.5%), and relaparotomy (7/105; 6.7%). CONCLUSION The incidence of EPH observed in our institution is high. Appropriate patient selection for vaginal delivery and strict labor follow up with early intervention for labor abnormalities should be the guiding principles of optimal obstetrical care to alleviate the burden of uterine rupture.
Collapse
Affiliation(s)
- Mehari Bayable
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekitie Wondafrash
- St. Paul's Institute for Reproductive Health and Rights, Addis Ababa, Ethiopia
| | - Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy. J Clin Med 2022; 11:jcm11237063. [PMID: 36498640 PMCID: PMC9741336 DOI: 10.3390/jcm11237063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
Caesarean Scar Pregnancy (CSP) is an ectopic pregnancy with implantation into the niche of the uterine scar. We aimed to describe the local management of consecutive cases of CSP to develop a standard operating procedure (SOP). Between December 2019 and June 2022, there were 19,100 maternities. Of these, 23 were CSPs in 19 patients. Median BMI was 29 (range 20.5-52), median number of Caesarean deliveries (CS) was 2 (range 1-4) and 7/23 (30%) were cigarette smokers. At diagnosis, 9/23 were live pregnancies, 3/23 were retained products of conception (RPOC), 9/23 were pregnancies of uncertain viability (PUV), and 2/23 were non-viable. In six, the initial management was expectant, surgical suction evacuation with transrectal ultrasound guidance in 16, and one had a hysterectomy. The median blood loss was 100 mL (range 50-2000 mL). Two patients (9%) required a blood transfusion. Median hospital stay was 1 day (range 0-4). At follow-up after 10 weeks, no patients had an ongoing haematoma, and one had significant RPOC electing hysterectomy. Eight women were known to have 9 subsequent pregnancies (recurrent CSP n = 4, livebirth n = 2, miscarriage n = 2, tubal ectopic n = 1). Outcomes as rated by low blood loss, short hospital stay, and rare need for further intervention were favorable. Factors associated included prompt ultrasonographic diagnosis, availability of transrectal ultrasound guided surgery, and specialist follow-up, which form the basis of the SOP.
Collapse
|
7
|
Sallée C, Margueritte F, Marquet P, Piver P, Aubard Y, Lavoué V, Dion L, Gauthier T. Uterine Factor Infertility, a Systematic Review. J Clin Med 2022; 11:jcm11164907. [PMID: 36013146 PMCID: PMC9410422 DOI: 10.3390/jcm11164907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.
Collapse
Affiliation(s)
- Camille Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
- Correspondence: ; Tel.: +33-555-055-555
| | - François Margueritte
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 78103 Poissy, France
| | - Pierre Marquet
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042 Limoges, France
| | - Pascal Piver
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Yves Aubard
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Tristan Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| |
Collapse
|
8
|
Gulucu S, Uzun KE, Ozsoy AZ, Delibasi IB. Retrospective evaluation of peripartum hysterectomy patients: 8 years' experience of tertiary health care. Niger J Clin Pract 2022; 25:483-489. [PMID: 35439908 DOI: 10.4103/njcp.njcp_1722_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Peripartum hysterectomy (PPH), which means surgical removal of the uterus during pregnancy or postpartum period, is a life-saving procedure performed as a last resort to stop obstetric serious bleeding. Aim Evaluation of the prevalence, risk factors, indications, associated complications, and neonatal outcomes of PPH performed in our clinic. Patients and Methods A total of 35 patients who underwent PPH in our clinic between 2013 and 2020 were analyzed retrospectively. Clinical and demographic characteristics of patients, age, gestational week, delivery type, type of hysterectomy performed, length of hospital stay, PPH indications, additional procedures and complications during PPH, maternal and fetal mortality, neonatal characteristics, intensive care unit (ICU) need after PPH, and blood transfusion amount and time were recorded. Patients with PPH were subdivided and studied in subgroups: Emergency - elective surgery, total - subtotal hysterectomy. Results PPH was performed in 35 (3.2/1000) patients who gave birth during the study period. The most common indication for hysterectomy was placental invasion anomaly (57.1%, n = 20), and the most performed operation was total hysterectomy (68.6%, n = 24). Bilateral hypogastric artery ligation (14.3%, n = 5) was the most common alternative procedure performed before hysterectomy, and the most common complication was bladder injury (22.9%, n = 8). Blood transfusion was performed in 94.3% (n = 33) of the patients due to acute blood loss. The mean newborn weight was 2788.79 ± 913.37 g, and the 1st and 5th-minute APGAR scores were 6.71 ± 2.25 and 7.56 ± 2.35, respectively. Conclusion Before PPH, uterine integrity should be preserved using medical and surgical methods, but if success is not achieved, hysterectomy is the last life-saving step. It should be kept in mind that in patients with anemia and increased gravidity, the risk of bleeding may be high in the first 24 h after birth and therefore PPH may be required. It would be more appropriate for patients with placentation anomalies to be operated in experienced centers due to possible complications, increased blood transfusion, and intensive care requirement.
Collapse
Affiliation(s)
- S Gulucu
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
| | - K E Uzun
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
| | - A Z Ozsoy
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
| | - I B Delibasi
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
| |
Collapse
|
9
|
Chung RK, Salari S, Findley J, Richards EG, Flyckt RLR. Uterine Transplantation: Recipient Patient Populations. Clin Obstet Gynecol 2022; 65:15-23. [PMID: 35045021 DOI: 10.1097/grf.0000000000000672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Uterine transplantation is an emerging treatment for patients with uterine factor infertility (UFI). In order to determine patient candidacy for transplant, it is imperative to understand how to identify, counsel and treat uterine transplant recipients. In this article, we focus on patient populations with UFI, whether congenital or acquired, including Mayer-Rokitansky-Kuster-Hauser, complete androgen insensitivity syndrome, hysterectomy, and other causes of nonabsolute UFI. Complete preoperative screening of recipients should be required to assess the candidacy of each individual prior to undergoing this extensive treatment option.
Collapse
Affiliation(s)
- Rebecca K Chung
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| | - Salomeh Salari
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| | - Joseph Findley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| | | | - Rebecca L R Flyckt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Beachwood
| |
Collapse
|
10
|
Gică N, Ragea C, Botezatu R, Peltecu G, Gică C, Panaitescu AM. Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010111. [PMID: 35056419 PMCID: PMC8780271 DOI: 10.3390/medicina58010111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.
Collapse
Affiliation(s)
- Nicolae Gică
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Carina Ragea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
| | - Radu Botezatu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Corina Gică
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
- Correspondence:
| |
Collapse
|
11
|
Mauney L, Barth WH, Clapp MA. Association between peripartum hysterectomy and venous thromboembolism. Am J Obstet Gynecol 2022; 226:119.e1-119.e11. [PMID: 34224689 DOI: 10.1016/j.ajog.2021.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of venous thromboembolism after delivery is modified by mode of delivery, with the risk of venous thromboembolism being higher after cesarean delivery than vaginal delivery. The risk of venous thromboembolism after peripartum hysterectomy is largely unknown. OBJECTIVE This study aimed to compare the incidence and risk of venous thromboembolism among women who had and did not have a peripartum hysterectomy. Furthermore, we sought to compare the risk of venous thromboembolism after hysterectomy with other patient, pregnancy, and delivery risk factors known to be associated with venous thromboembolism. STUDY DESIGN This was a cross-sectional study of women with delivery encounters identified in the Nationwide Readmissions Database from October 2015 to December 2017. Delivery encounters and all variables of interest were identified using the International Classification of Diseases, Tenth Revision diagnosis and procedure codes. The incidence of venous thromboembolism during delivery and rehospitalizations within 6 weeks after discharge was compared among women who had and did not have a peripartum hysterectomy. Multivariable logistic regressions were used to estimate associations between venous thromboembolism and hysterectomy, adjusted for the following characteristics: maternal age, payer at time of delivery, obesity, hypertension, diabetes mellitus, tobacco use, multifetal gestation, peripartum infection, and peripartum hemorrhage. Similarly, venous thromboembolism risk was compared by mode of delivery, including hysterectomy. Diagnoses that may have been indications for peripartum hysterectomy were identified among patients who underwent a hysterectomy and compared between those who did and did not have venous thromboembolism. Analyses used survey weights to obtain population estimates. RESULTS Of the 4,419,037 women with deliveries, 5098 (11.5 per 10,000 deliveries) underwent a hysterectomy. Moreover, 110 patients (215.8 per 10,000 deliveries) were diagnosed with venous thromboembolism after hysterectomy. The risk of venous thromboembolism was significantly higher in women who underwent a hysterectomy than in women who did not have a hysterectomy (unadjusted odds ratio, 25.1 [95% confidence interval, 20.0-31.5]; adjusted odds ratio, 11.2 [95% confidence interval, 8.7-14.5]; P<.001). Comparing the risk of venous thromboembolism by mode of delivery, the unadjusted and adjusted incidences of venous thromboembolism were 6.9 (95% confidence interval, 6.5-7.3) and 7.4 (95% confidence interval, 6.9-7.8) per 10,000 deliveries among women after vaginal delivery without peripartum hysterectomy, 12.5 (95% confidence interval, 11.8-13.1) and 11.3 (95% confidence interval, 10.7-12.0) per 10,000 deliveries after cesarean delivery without hysterectomy; and 217.2 (95% confidence interval, 169.1-265.2) and 96.9 (95% confidence interval 76.9-126.5) per 10,000 deliveries after hysterectomy, regardless of mode of delivery. Of the 110 diagnoses of venous thromboembolism with peripartum hysterectomy, 89 (81%) occurred during delivery admission. Of the remaining 21 cases, 50% occurred within the first 10 days after discharge from delivery, and 75% occurred within 25 days after discharge. CONCLUSION These findings have demonstrated that peripartum hysterectomy is associated with a markedly increased risk of venous thromboembolism in the postpartum period, even when controlling for other known risk factors for postpartum thromboembolic events. Here, the incidence of venous thromboembolism after peripartum hysterectomy (2.2%) met some guideline-based risk thresholds for routine thromboprophylaxis, potentially for at least 2 weeks after delivery. Further investigation into the role of routine venous thromboembolism prophylaxis during and after delivery is needed.
Collapse
Affiliation(s)
- Logan Mauney
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA.
| | - William H Barth
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark A Clapp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
12
|
Emergency peripartum hysterectomy: Five-year experience in a university hospital. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.987243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Ade-Ojo IP, Tijani O. A Review on the Etiology, Prevention, and Management of Ureteral Injuries During Obstetric and Gynecologic Surgeries. Int J Womens Health 2021; 13:895-902. [PMID: 34621135 PMCID: PMC8491787 DOI: 10.2147/ijwh.s330060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
Iatrogenic ureteral injuries are a rare but serious complication of some gynecological and obstetric procedures with both high morbidity and legal implications. The incidence varies widely depending on the type and extent of the surgeries with about 70% unrecognized intraoperatively. When recognized intraoperatively and promptly managed, the prognosis is good. Ureteral injuries recognized postoperatively come with dire consequences for the patients and are litigation prone. Due to the proximity of the lower half of the ureters to the pelvic organs, 50% of the cases of injuries to the ureter occur within the jurisdiction of gynecological and obstetric practice. A good knowledge of the etiology, predisposing factors, appropriate surgical skills, proper identification of the course and deviation of the ureters, and intraoperative recognition of inadvertent damage to the ureter and its vasculature is required by all obstetricians and gynecologists to reduce the incidence of ureteral injuries by at least 50%. This review aims to add to what is already known, particularly among obstetricians and gynecologists practicing in resource-constrained settings.
Collapse
Affiliation(s)
- Idowu Pius Ade-Ojo
- Department of Obstetrics Gynecology, Ekiti State University, Ado-Ekiti, Nigeria
| | - Olatoyosi Tijani
- Department of Obstetrics and Gynecology, Ekiti State University Hospital, Ado-Ekiti, Nigeria
| |
Collapse
|
14
|
Bogardus MH, Wen T, Gyamfi-Bannerman C, Wright JD, Goffman D, Sheen JJ, D'Alton ME, Friedman AM. Racial and Ethnic Disparities in Peripartum Hysterectomy Risk and Outcomes. Am J Perinatol 2021; 38:999-1009. [PMID: 34044460 DOI: 10.1055/s-0041-1729879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to determine whether race and ethnicity contribute to risks associated with peripartum hysterectomy. STUDY DESIGN This retrospective cross-sectional study utilized the 2000-2014 Nationwide Inpatient Sample to analyze risk of peripartum hysterectomy and associated severe maternal morbidity, mortality, surgical injury, reoperation, surgical-site complications, and mortality by maternal race and ethnicity. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, other, and unknown. Multivariable log-linear regression models including patient, clinical, and hospital risk factors were performed with adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). RESULTS Of 59,854,731 delivery hospitalizations, there were 45,369 peripartum hysterectomies (7.6 per thousand). Of these, 37.8% occurred among non-Hispanic white, 13.9% among non-Hispanic black, and 22.8% among Hispanic women. In adjusted analyses, non-Hispanic black (aRR: 1.21, 95% CI: 1.17-1.29) and Hispanic women (aRR: 1.25, 95% CI: 1.22-1.29) were at increased risk of hysterectomy compared with non-Hispanic white women. Risk for severe morbidity was increased for non-Hispanic black (aRR: 1.25, 95% CI: 1.19-1.33), but not for Hispanic (aRR: 1.02, 95% CI: 0.97-1.07) women. Between these three groups, risk for intraoperative complications was highest among non-Hispanic white women, risk for reoperation was highest among Hispanic women, and risk for surgical-site complications was highest among non-Hispanic black women. Evaluating maternal mortality, non-Hispanic black women (RR: 3.83, 95% CI: 2.65-5.53) and Hispanic women (RR: 2.49, 95% CI: 1.74-3.59) were at higher risk than non-Hispanic white women. CONCLUSION Peripartum hysterectomy and related complications other than death differed modestly by race. In comparison, mortality differentials were large supporting that differential risk for death in the setting of this high-risk scenario may be an important cause of disparities. KEY POINTS · Peripartum hysterectomy and related complications differed modestly by race.. · Mortality differentials in the setting of peripartum hysterectomy were large.. · Failure to rescue may be an important cause of peripartum hysterectomy disparities..
Collapse
Affiliation(s)
- Margaret H Bogardus
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Dena Goffman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jean-Ju Sheen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
15
|
Pregnancy-Related Hysterectomy for Peripartum Hemorrhage: A Literature Narrative Review of the Diagnosis, Management, and Techniques. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9958073. [PMID: 34307683 PMCID: PMC8282389 DOI: 10.1155/2021/9958073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Postpartum hemorrhage is a life-threatening situation, in which hysterectomy can be performed to prevent maternal death. However, it is associated with high rates of maternal morbidity and mortality and permanent infertility. The incidence of pregnancy-related hysterectomy varies across countries, but its main indications are the following: uterine atony and placenta spectrum (PAS) disorders. PAS disorder prevalence is rising during the last years, mainly due to the increased number of cesarean sections. As a result, obstetricians should be aware of the difficulties of this emergent condition and improve its accurate antenatal diagnosis rates, as well as its modern management strategies. Of course, special skills are required during a pregnancy-related hysterectomy, so these patients should be referred to centers of excellence in antenatal care, where a multidisciplinary team approach is followed. This study is a narrative review of the literature of the last 5 years (PubMed, Cochrane) regarding postpartum hemorrhage to offer obstetricians up-to-date knowledge on this pregnancy-related life-threatening issue. However, there is a lack of available high-quality data, because most published papers are retrospective case series or observational cohorts.
Collapse
|
16
|
Pathiraja PDM, Jayawardane A. Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on Patients' Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You Save the Life. Obstet Gynecol Int 2021; 2021:5720264. [PMID: 33679986 PMCID: PMC7906802 DOI: 10.1155/2021/5720264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/06/2021] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Peripartum hysterectomy can be performed as an elective procedure or as a life-saving emergency procedure in obstetrics. It is associated with significant maternal morbidity and mortality. We report peripartum hysterectomies done during the study period in a tertiary referral centre, Colombo, Sri Lanka. Methodology. We collected data on all severe acute maternal morbidity and mortality events (SAMM) from June 01, 2014, to June 01, 2015, at De Soysa Hospital for Women (DSHW). We invited all women who underwent PPH to complete the 36-Item Short Form Health Survey questionnaire (SF-36) before hospital discharge and at six months after the hysterectomy date to assess their general and mental health before and after surgery. Focus group discussions (FGD) were used to further evaluate the patient experience and to identify service delivery improvements. RESULTS There were eleven peripartum hysterectomies done during the study period for 7160 deliveries. None were primigravida. Median age and gestation were 36 years and 37 weeks, respectively. The commonest indication for peripartum hysterectomy was a morbidly adherent placenta (seven). Nine of the deliveries were elective lower-segment caesarean section and two were vaginal deliveries. Four emergency peripartum hysterectomies were done for primary postpartum haemorrhage (PPH) and two for secondary PPH. All patients required intensive care and there were no maternal deaths. The analysis of SF-36 data revealed that all patients suffered a significant reduction in the quality of life at six months after the surgery. FGD highlighted that most patients needed further counselling and support to improve their physical, psychological, and social wellbeing. Some of the patients were willing to share their experience on voluntary basis to help those undergoing peripartum hysterectomies in the future. CONCLUSION Peripartum hysterectomy is an important life-saving procedure associated with severe maternal morbidity and mortality. This study reveals that the physical, psychological, and social adverse effects would remain in the long term.
Collapse
|
17
|
Annan JJK, Konney TO, Sam-Awortwi W, Darkwa KA. Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study. Pan Afr Med J 2020; 37:106. [PMID: 33425139 PMCID: PMC7757309 DOI: 10.11604/pamj.2020.37.106.25393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies. We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. Methods an ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1st January 2018 to 31st December 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables. Results there were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH): 73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as 'others **': two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products. Conclusion emergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team.
Collapse
Affiliation(s)
- John Jude Kweku Annan
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas Opkoti Konney
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wilfred Sam-Awortwi
- Department of Anaesthesiology and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwasi Ampem Darkwa
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| |
Collapse
|
18
|
Emergency peripartum hysterectomy at Jordan University hospital - a teaching hospital experience. MENOPAUSE REVIEW 2020; 19:66-71. [PMID: 32802016 PMCID: PMC7422286 DOI: 10.5114/pm.2020.97840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/21/2020] [Indexed: 11/28/2022]
Abstract
Introduction Emergency peripartum hysterectomy (EPH) is a foremost operation and is perpetually implemented in the presence of life intimidating hemorrhage during or immediately after abdominal or vaginal deliveries. The aim of this study was to review cases managed at the Department of Gynecology and Obstetrics at Jordan University Hospital (JUH). Material and methods All women who underwent EPH due to any cause in the period from January 2010, to December 2017 were included in the study. Data were collected retrospectively using the patients’ files namelessly. Main measures: age, gravidity, parity, number of previous cesarean sections, previous uterine surgeries, indication for hysterectomy, complications, antepartum bleeding and the need for blood transfusion. Results In total, 74 cases of EPH were managed during the study period. The incidence of EPH ranged from 0.24 to 8.7 per 1000 deliveries. EPH was found to be more common following cesarean sections than vaginal deliveries. The prime indication was abnormal placentation, uterine atony, and uterine rupture. The risk factors included previous cesarean sections, scarred uteruses, multiparity, older age group. Maternal morbidity ranged from 26.5 to 31.5% and mortality from 0 to 12.5% with a mean of 4.8%. Conclusions EPH is the most demanding obstetric surgery performed in very tiresome circumstances of life threatening hemorrhage. The indication for EPH in recent years has changed from outdated uterine atony to abnormal placentation. Antenatal eagerness of the risk factors, engrossment of proficient obstetricians at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in tumbling morbidity and mortality.
Collapse
|
19
|
Kallianidis AF, Maraschini A, Danis J, Colmorn LB, Deneux-Tharaux C, Donati S, Gissler M, Jakobsson M, Knight M, Kristufkova A, Lindqvist PG, Vandenberghe G, Van Den Akker T. Epidemiological analysis of peripartum hysterectomy across nine European countries. Acta Obstet Gynecol Scand 2020; 99:1364-1373. [PMID: 32358968 PMCID: PMC7540498 DOI: 10.1111/aogs.13892] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries. MATERIAL AND METHODS We performed a descriptive, multinational, population-based study among women who underwent peripartum hysterectomy. Data were collected from national or multiregional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48 hours postpartum for obstetric hemorrhage, as this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section. RESULTS A total of 1302 peripartum hysterectomies were performed in 2 498 013 births, leading to a prevalence of 5.2 per 10 000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared with vaginal birth was 9.1 (95% CI 8.0-10.4). Relative risk for hysterectomy for birth after previous cesarean section compared with birth without previous cesarean section was 10.6 (95% CI 9.4-12.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (ρ = 0.67, P < .05). CONCLUSIONS Prevalence of peripartum hysterectomy may vary considerably between high-income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine-fold increased risk of peripartum hysterectomy.
Collapse
Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Jakub Danis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lotte B Colmorn
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cite, Paris University, Paris, France
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää hospital HUCH, University of Helsinki, Helsinki, Finland
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pelle G Lindqvist
- Clinical Science and Education, Department of Obstetrics and Gynecology, Karolinska Institute, Sodersjukhuset Hospital, Stockholm, Sweden
| | - Griet Vandenberghe
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Van Den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Athena Institute, VU University Amsterdam, The Netherlands
| | | |
Collapse
|
20
|
Visser GHA. Trial of vaginal breech delivery in carefully selected women is worth considering-Fruit for thought! Eur J Obstet Gynecol Reprod Biol 2020; 252:574-575. [PMID: 32279984 DOI: 10.1016/j.ejogrb.2020.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
There remains uncertainty about the optimal route of delivering carefully selected breech babies at term. This review argues strongly that vaginal mode of delivery should be considered in selected cases rather than offering an elective caesarean section for every patient.
Collapse
Affiliation(s)
- Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, the Netherlands.
| |
Collapse
|
21
|
PEKER N, TURAN G, AYDIN E, YAVUZ M, EGE S, BADEMKIRAN MH, KARAÇOR T, GÜL T. Analysis of Patients Undergoing Peripartum Hysterectomy for Obstetric Causes According to Delivery Methods: 13-Year Experience of a Tertiary Center. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.706086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Horazeck C, Crockett CJ. Saved by the Massive Transfusion Protocol: A Case Report of an Obstetric Patient With Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome and Glisson Capsule Rupture. A A Pract 2019; 12:409-411. [PMID: 31162171 DOI: 10.1213/xaa.0000000000000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 31-year-old primigravid parturient with no pertinent medical history was admitted at 40 weeks and 4 days of gestation for postdate induction of labor. She was subsequently diagnosed with preeclampsia and developed hemolysis, elevated liver enzymes, and a low platelet count. An emergency cesarean delivery ensued owing to fetal bradycardia. Massive hemorrhage occurred on incision, and a diagnosis of ruptured subcapsular hepatic hematoma was made. The hemorrhage was managed using our institution's massive transfusion protocol. Early transfusions and mobilization of necessary support stipulated in this protocol led to full recovery of the patient, with no significant morbidity.
Collapse
Affiliation(s)
- Christian Horazeck
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Christy J Crockett
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
23
|
Combining Clinical Characteristics and Specific Magnetic Resonance Imaging Features to Predict Placenta Accreta. J Comput Assist Tomogr 2019; 43:775-779. [PMID: 31356517 PMCID: PMC6752690 DOI: 10.1097/rct.0000000000000894] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to explore the independent clinical and magnetic resonance imaging (MRI) performance risk factors for predicting placenta accreta.
Collapse
|
24
|
Heitkamp A, Seinstra J, Akker T, Vollmer L, Gebhardt S, Roosmalen J, Vries JI, Theron G. A district‐wide population‐based descriptive study of emergency peripartum hysterectomy in a middle‐income country. Int J Gynaecol Obstet 2019; 146:103-109. [DOI: 10.1002/ijgo.12837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/16/2019] [Accepted: 05/02/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Anke Heitkamp
- Department of Obstetrics and Gynecology Stellenbosch University and Tygerberg Academic Hospital Cape Town South Africa
- Department of Obstetrics and Gynecology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Jorrit Seinstra
- Department of Obstetrics and Gynaecology Leiden University Medical Center Leiden the Netherlands
| | - Thomas Akker
- Department of Obstetrics and Gynaecology Leiden University Medical Center Leiden the Netherlands
| | - Linda Vollmer
- Department of Obstetrics and Gynecology Stellenbosch University and Tygerberg Academic Hospital Cape Town South Africa
| | - Stefan Gebhardt
- Department of Obstetrics and Gynecology Stellenbosch University and Tygerberg Academic Hospital Cape Town South Africa
| | - Jos Roosmalen
- Department of Obstetrics and Gynaecology Leiden University Medical Center Leiden the Netherlands
- Athena Institute Vrije Universiteit Amsterdam the Netherlands
| | - Johanna I. Vries
- Department of Obstetrics and Gynecology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Gerhard Theron
- Department of Obstetrics and Gynecology Stellenbosch University and Tygerberg Academic Hospital Cape Town South Africa
| |
Collapse
|
25
|
Lee HJ, Cho HY, Peck MJ, Ki HJ, Moon MJ, Kim HC, Jang SW, Kim YR. Uterine artery embolization versus cesarean hysterectomy in the management of postpartum hemorrhage. MINIM INVASIV THER 2019; 28:351-358. [DOI: 10.1080/13645706.2018.1562943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hyun Jung Lee
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Min Joo Peck
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyo Jin Ki
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Myoung Jin Moon
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Sung Woon Jang
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Young Ran Kim
- Department of Obstetrics and Gynecology, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| |
Collapse
|
26
|
Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, Gibbons D, Kelly NM, Kennedy HP, Kidanto H, Taylor P, Temmerman M. Short-term and long-term effects of caesarean section on the health of women and children. Lancet 2018; 392:1349-1357. [PMID: 30322585 DOI: 10.1016/s0140-6736(18)31930-5] [Citation(s) in RCA: 576] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 02/08/2023]
Abstract
A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose-response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.
Collapse
Affiliation(s)
- Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK.
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK
| | - Lisa Avery
- Department of Community Health Sciences, Centre for Global Public Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Glen Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Department of Obstetrics and General Hospital, Port Moresby, Papua New Guinea
| | - Gerard Ha Visser
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| | - Caroline Se Homer
- Maternal and Child Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - Deena Gibbons
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London UK
| | - Niamh M Kelly
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK
| | | | | | - Paul Taylor
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas' Hospital Campus, King's College London, London UK
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
27
|
An alternate surgical approach to reduce hemorrhage and complications during cesarean hysterectomy for adherent placenta. Eur J Obstet Gynecol Reprod Biol 2018; 228:215-220. [DOI: 10.1016/j.ejogrb.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 06/14/2018] [Accepted: 07/02/2018] [Indexed: 01/03/2023]
|
28
|
Huque S, Roberts I, Fawole B, Chaudhri R, Arulkumaran S, Shakur-Still H. Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial. BMC Pregnancy Childbirth 2018; 18:186. [PMID: 29843627 PMCID: PMC5975404 DOI: 10.1186/s12884-018-1829-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/15/2018] [Indexed: 12/25/2022] Open
Abstract
Background Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. Methods We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. Results Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7–3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6–5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9–1.7). Conclusions Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia.
Collapse
Affiliation(s)
- Sumaya Huque
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Bukola Fawole
- Department of Obstetrics and Gynaecology, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Orita-Mefa, Ibadan, Nigeria
| | - Rizwana Chaudhri
- Department of Obstetrics and Gynaecology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Haleema Shakur-Still
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
29
|
Tahlak MA, Abdulrahman M, Hubaishi NM, Omar M, Cherifi F, Magray S, Carrick FR. Emergency peripartum hysterectomy in the Dubai health system: A fifteen year experience. Turk J Obstet Gynecol 2018; 15:1-7. [PMID: 29662708 PMCID: PMC5894529 DOI: 10.4274/tjod.55492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/07/2017] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine the incidence, demographic data, risk factors, indications, outcome and complications of emergency peripartum hysterectomy (EPH) performed in two major tertiary care hospitals in Dubai, and to compare the results with the literature. Materials and Methods: The records of all women who underwent EPH from January 2000 to December 2015 in two major tertiary care hospitals in Dubai were accessed and reviewed. Maternal characteristics, hysterectomy indications, outcomes, and postoperative complications were recorded using descriptive statistics to describe the cohort. Results: There were 79 EPH out of 168.293 deliveries, a rate of 0.47/1000 deliveries. The most common indications for hysterectomy were abnormal placentation (previa and/or accreta) and uterine atony. The majority of hysterectomies were subtotal (70%). The complications were dominated by massive transfusion, urinary tract injuries, one case of maternal death, and one case of neonatal death. Conclusion: The main indication for EPH was abnormal placentation in scarred uterus and uterine atony. The major method of prevention of EPH is to assess women’s risks and to reduce the number of cesarean section deliveries, by limiting the rate of primary cesareans. This is challenging in the United Arab Emirates (UAE) where the culture is for high gravidity and high parity. Recommendations to act to reduce primary and repeated cesareans should be included on the national agenda in UAE.
Collapse
Affiliation(s)
- Muna Abdulrazzaq Tahlak
- Dubai Health Authority, Latifa Women and Children Hospital, Clinic of Obstetrics and Gynegology Dubai, United Arab Emirates
| | - Mahera Abdulrahman
- Dubai Health Authority, Clinic of Medical Education, Dubai, United Arab Emirates
| | - Nawal Mahmood Hubaishi
- Dubai Health Authority, Dubai Hospital, Clinic of Obstetrics and Gynegology, Dubai, United Arab Emirates
| | - Mushtaq Omar
- Dubai Health Authority, Latifa Women and Children Hospital, Clinic of Obstetrics and Gynegology Dubai, United Arab Emirates
| | - Fatima Cherifi
- Dubai Health Authority, Dubai Hospital, Clinic of Obstetrics and Gynegology, Dubai, United Arab Emirates
| | - Shazia Magray
- Dubai Health Authority, Latifa Women and Children Hospital, Clinic of Obstetrics and Gynegology Dubai, United Arab Emirates
| | - Frederick Robert Carrick
- Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Department of Neurology and Senior Research, Cambridge, United Kingdom.,Harvard Medical School-Harvard Macy Institute, Clinic of Nevrology, Boston, USA.,Carrick Institute, Cape Canaveral, Clinic of Nevrology, Florida, USA
| |
Collapse
|
30
|
|
31
|
Zhang Y, Yan J, Han Q, Yang T, Cai L, Fu Y, Cai X, Guo M. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage: A 12-year review. Medicine (Baltimore) 2017; 96:e8443. [PMID: 29137030 PMCID: PMC5690723 DOI: 10.1097/md.0000000000008443] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to review the operative experiences of emergency hysterectomy for life-threatening postpartum hemorrhage (PPH) performed over a 12-year period at Fujian Provincial Maternity and Children's Hospital; to examine the incidence and risk factors for emergency obstetric hysterectomy; and to evaluate the curative effectiveness and safety of subtotal hysterectomy for life-threatening PPH.The records of all cases of emergency obstetric hysterectomy performed at Fujian Maternity and Children Health Hospital between January 2004 and June 2016 were analyzed. The incidence, risk factors, and outcomes of hysterectomy, the peripartum complications, and the coagulation function indices were evaluated.A total of 152,023 of women were delivered. The incidence of emergency postpartum hysterectomy was 0.63 per 1000 deliveries: 96 patients underwent hysterectomy for uncontrolled PPH, 19 (0.207‰) underwent hysterectomy following vaginal delivery, and 77 (1.28‰) underwent the procedure following cesarean delivery (P < .001). Common risk factors included postpartum prothrombin activity ≤ 50% (61.5%), placenta accreta (43.76%), uterine atony (37.5%), uterine rupture (17.5%), and grand multiparity > 6 (32.3%). Forty-one patients underwent subtotal abdominal hysterectomy (STH) and 55 patients underwent total abdominal hysterectomy (TH). The mean operation time was significantly shorter for TH (193.59 ± 83.41 minutes) than for STH (142.86 ± 78.32 minutes; P = .002). The mean blood loss was significantly greater for TH (6832 ± 787 mL) than for STH (6329 ± 893 mL; P = .003). The mean number of red cell units transfusion was higher during TH (16.24 ± 9.48 units vs 12.43 ± 7.2, respectively; P = .047). Postoperative prothrombin activity was significantly higher than preoperative levels (56.84 ± 14.74 vs 44.39 ± 15.69, respectively; P < .001) in women who underwent TH and in those who underwent STH (57.63 ± 15.68 vs 47.87 ± 12.86, respectively; P < .001). There was no significant difference in the maternal complications after TH or STH for PPH.Cesarean deliveries were associated with an increased risk of emergency hysterectomy, and postpartum prothrombin activity < 50% was the greatest risk factor for hysterectomy in most women who underwent hysterectomy. STH was the preferred procedure for emergency obstetric hysterectomy.
Collapse
|
32
|
Akintayo AA, Olagbuji BN, Aderoba AK, Akadiri O, Olofinbiyi BA, Bakare B. Emergency Peripartum Hysterectomy: A Multicenter Study of Incidence, Indications and Outcomes in Southwestern Nigeria. Matern Child Health J 2017; 20:1230-6. [PMID: 26961244 DOI: 10.1007/s10995-016-1924-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To determine the incidence, indications and outcomes of emergency peripartum hysterectomy (EPH) in three tertiary institutions in south-west Nigeria between January, 2010 and December , 2013. Methods A retrospective review of all cases of EPH over a 4 year period was done. EPH was defined as hysterectomy performed at the time of delivery or within 24 h of delivery for uncontrollable postpartum bleeding not responsive to conservative measures. Relevant information was extracted from the hospital records and operation notes. Statistical analysis was done using SPSS software version 17.0. Statistical significance was set at p < 0.05. Results There were 102 EPHs performed among 39,738 deliveries within the study period, giving a rate of 2.6 per thousand deliveries. Indications were uterine rupture (44.1 %), uterine atony (37.3 %), morbidly adherent placenta (17.6 %) and extension of caesarean section incision involving the uterine arteries (1 %). Subtotal hysterectomy was performed in most cases (67.6 %).Maternal case fatality rate was 11.8 % and perinatal mortality rate was 55.9 %. Blood transfusion, severe postoperative anaemia, wound sepsis, febrile morbidity and acute kidney injury were common morbidities associated with the procedure. Following multivariate logistic regression, the unbooked status [odds-ratio 95 % CI = 12.80 (1.22-133.97) p = 0.03] was the only variable that significantly predicted maternal death. Conclusion The incidence of EPH from our study is high. Much more needs to be done in maternal health services, particularly provision of quality obstetric care to reduce the rates of EPH and the associated high maternal and perinatal morbidity and mortality.
Collapse
Affiliation(s)
- A A Akintayo
- Department of Obstetrics and Gynecology, Ekiti State University, Ado-Ekiti, Nigeria.
| | - B N Olagbuji
- Department of Obstetrics and Gynecology, Ekiti State University, Ado-Ekiti, Nigeria.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - A K Aderoba
- Department of Obstetrics and Gynaecology, Mother and Child Hospital, Akure, Nigeria
| | - O Akadiri
- Department of Obstetrics and Gynecology, Ondo State Specialist Hospital, Ondo, Nigeria
| | - B A Olofinbiyi
- Department of Obstetrics and Gynecology, Ekiti State University, Ado-Ekiti, Nigeria
| | - B Bakare
- Department of Obstetrics and Gynecology, Ondo State Specialist Hospital, Ondo, Nigeria
| |
Collapse
|
33
|
Kilicci C, Ozkaya E, Eser A, Bostanci EE, Sanverdi I, Abide Yayla C, Tozkir E, Eser SK. Planned cesarean hysterectomy versus modified form of segmental resection in patients with placenta percreta. J Matern Fetal Neonatal Med 2017; 31:2935-2940. [DOI: 10.1080/14767058.2017.1359535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cetin Kilicci
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Enis Ozkaya
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Eser
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Evrim Ergen Bostanci
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Ilhan Sanverdi
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Abide Yayla
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Elif Tozkir
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Semra Kayatas Eser
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
34
|
Abstract
OBJECTIVE To characterize where women at risk for and undergoing peripartum hysterectomy delivered in terms of obstetric volume and procedural experience. METHODS We used data from the Perspective database to retrospectively evaluate trends in peripartum hysterectomy and deliveries at high risk of peripartum hysterectomy based on placenta previa and prior cesarean delivery delivered from 2006 through 2014. Hospitals were categorized two separate ways for the analysis: 1) into five roughly equal quintiles based on annualized delivery volume and 2) by the mean number of hysterectomies performed annually over the study period. RESULTS Four thousand eight hundred eleven hysterectomies occurred among 5,388,486 deliveries in 500 hospitals over the study period. The peripartum hysterectomy rate increased from 81.4 per 100,000 deliveries in 2006 to 98.4 in 2014. The prevalence rate of placenta previa in the setting of previous cesarean delivery also increased over the study period. Between 2006-2008 and 2012-2014, peripartum hysterectomy decreased in the lowest delivery volume quintile and increased in the highest delivery volume quintile (-14.9/100,000 deliveries, 95% confidence interval [CI] -25.6 to -4.2 and +35.4/100,000 deliveries, 95% CI 20.3-50.5, respectively). Similarly, hospitals performing high rates of hysterectomies saw the largest increase over the study period. CONCLUSION With peripartum hysterectomy rates increasing in the population, hospitals with high delivery volumes and high rates of hysterectomies saw the largest increases in peripartum hysterectomy rates. These trends support that improved referral practices and uptake of evidence-based recommendations may be occurring.
Collapse
|
35
|
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.
Collapse
|
36
|
Abstract
Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.
Collapse
|
37
|
Charoenraj P, Charuluxananan S, Chatrkaw P, Tunprasit C, Wangdumrongwong P, Phupong V. Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial.
Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes.
Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P < 0.05 was considered significant.
Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P < 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate >125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P < 0.001.
Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.
Collapse
Affiliation(s)
- Pornarun Charoenraj
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Somrat Charuluxananan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Phornlert Chatrkaw
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chooksak Tunprasit
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Parinya Wangdumrongwong
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Vorapong Phupong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| |
Collapse
|
38
|
Gillespie C, Sangi-Haghpeykar H, Munnur U, Suresh MS, Miller H, Hawkins SM. The effectiveness of a multidisciplinary, team-based approach to cesarean hysterectomy in modern obstetric practice. Int J Gynaecol Obstet 2017; 137:57-62. [DOI: 10.1002/ijgo.12093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/15/2016] [Accepted: 01/03/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Caitlin Gillespie
- School of Allied Health Science; Physician Assistant Program; Baylor College of Medicine; Houston TX USA
| | | | - Uma Munnur
- Department of Anesthesiology; Baylor College of Medicine; Houston TX USA
- Harris Health System; Houston TX USA
| | - Maya S. Suresh
- Department of Anesthesiology; Baylor College of Medicine; Houston TX USA
- Harris Health System; Houston TX USA
| | | | - Shannon M. Hawkins
- Department of Obstetrics and Gynecology; Baylor College of Medicine; Houston TX USA
- Harris Health System; Houston TX USA
| |
Collapse
|
39
|
Seoud MA, Nasr R, Berjawi GA, Zaatari GS, Seoud TM, Shatila AS, Mirza FG. Placenta accreta: Elective versus emergent delivery as a major predictor of blood loss. J Neonatal Perinatal Med 2017; 10:9-15. [PMID: 28304318 DOI: 10.3233/npm-1622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare blood loss and the use for blood transfusion between elective (planned) and emergent cesarean hysterectomy performed for placenta accreta by a single, multidisciplinary team and to present the team's pre-operative evaluation and the surgical technique. STUDY DESIGN Prospective cohort study at a single tertiary care center. Maternal and neonatal outcomes were compared between elective and emergent delivery of pregnancies complicated by placenta accreta. The primary outcomes were the need for blood transfusion and the number of units transfused. RESULTS A total of 28 cases of confirmed placenta accreta underwent peripartum hysterectomy, including 22 as elective and 6 as emergent. Eleven out of 22 (50%) subjects in the elective group received blood transfusion, while all subjects in the emergency group required transfusion (p = 0.03). More importantly, the number of units of packed red blood cells transfused was only 1.90 (±2.20) units in the elective cases compared to 7.83 (±4.90) units in cases performed emergently (p = 0.03). CONCLUSION Elective cesarean hysterectomy for this indication using a clearly outlined surgical approach is associated with significantly lower blood loss and hence less need for transfusion, compared to its emergent counterpart.
Collapse
Affiliation(s)
- M A Seoud
- Department of Obstetrics and Gynecology, Gynecologic Oncology, American University of Beirut, Beirut, Lebanon
| | - R Nasr
- Department of Surgery, Urology, American University of Beirut, Beirut, Lebanon
| | - G A Berjawi
- Department of Diagnostic Radiology, Women's Imaging, American University of Beirut, Beirut, Lebanon
| | - G S Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - T M Seoud
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - A S Shatila
- Department of Diagnostic Radiology, Women's Imaging, American University of Beirut, Beirut, Lebanon
| | - F G Mirza
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Columbia University, New York, NY, USA
| |
Collapse
|
40
|
Sharma B, Sikka P, Jain V, Jain K, Bagga R, Suri V. Peripartum hysterectomy in a tertiary care hospital: Epidemiology and outcomes. J Anaesthesiol Clin Pharmacol 2017; 33:324-328. [PMID: 29109629 PMCID: PMC5672527 DOI: 10.4103/joacp.joacp_380_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Peripartum hysterectomy is associated with significant maternal morbidity and mortality. We reviewed all peripartum hysterectomies at our institute over a 1-year period. The aim of this study was to determine the incidence, surgery and anesthesia-related issues of peripartum hysterectomies and to compare outcomes of emergency and electively planned peripartum hysterectomies. Material and Methods This was a retrospective analysis of records of women who underwent emergency or elective peripartum hysterectomy in a tertiary care hospital. The study included all women who underwent peripartum hysterectomy in a teaching hospital and referral institute in North India over a span of 1 year (April 1, 2014, to March 31, 2015). Association of variables was based on Chi-square test, Fisher's exact test, and comparison on "t" statistics (normal distribution) and Mann-Whitney (nonnormal distribution). Results Forty women underwent peripartum hysterectomy during the study period. The incidence was 6.9/1000 deliveries. In 16 (40%) cases, peripartum hysterectomy was planned electively while emergency hysterectomy was done in 24 (60%) cases. Main indications of peripartum hysterectomies were placenta accreta (60%), atonic postpartum hemorrhage (PPH) (27.5%), and uterine rupture (7.5%). Intensive care management was required in 35% women postoperatively. The common maternal complications were febrile morbidity, bladder injury, disseminated intravascular coagulation, and wound infection. There were 4 maternal deaths following emergency peripartum hysterectomy done for atonic PPH whereas no mortality occurred in elective hysterectomy group. Conclusions The most common indication for peripartum hysterectomy was placenta accrete. Electively planned peripartum hysterectomies with a multidisciplinary team approach had better outcomes and no mortality as compared to emergency peripartum hysterectomies.
Collapse
Affiliation(s)
- Bharti Sharma
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Bagga
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
41
|
Özcan HÇ, Uğur MG, Balat Ö, Bayramoğlu Tepe N, Sucu S. Emergency peripartum hysterectomy: single center ten-year experience. J Matern Fetal Neonatal Med 2016; 30:2778-2783. [DOI: 10.1080/14767058.2016.1263293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hüseyin Çağlayan Özcan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mete Gurol Uğur
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özcan Balat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Neslihan Bayramoğlu Tepe
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Seyhun Sucu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
42
|
Friedman AM, Wright JD, Ananth CV, Siddiq Z, D'Alton ME, Bateman BT. Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations. Am J Obstet Gynecol 2016; 215:640.e1-640.e8. [PMID: 27349293 DOI: 10.1016/j.ajog.2016.06.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/30/2016] [Accepted: 06/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postpartum hysterectomy is an obstetric procedure that carries significant maternal risk that is not well characterized by hospital volume. OBJECTIVE The objective of this study was to determine risk for peripartum hysterectomy for women at low and moderate risk for the procedure. STUDY DESIGN This population-based study used data from the Nationwide Inpatient Sample to characterize risk for peripartum hysterectomy. Women with a diagnosis of placenta accreta or prior cesarean and placenta previa were excluded. Obstetrical risk factors along with demographic and hospital factors were evaluated. Multivariable mixed-effects log-linear regression models were developed to determine adjusted risk. Based on these models receiver operating characteristic curves were plotted, and the area under the curve was determined to assess discrimination. RESULTS Peripartum hysterectomy occurred in 1 in 1913 deliveries. Risk factors associated with significant risk for hysterectomy included mode of delivery, stillbirth, placental abruption, fibroids, and antepartum hemorrhage. These factors retained their significance in adjusted models: the risk ratio for stillbirth was 3.44 (95% confidence interval, 2.94-4.02), abruption 2.98 (95% confidence interval, 2.52-3.20), fibroids 3.63 (95% confidence interval, 3.22-4.08), and antepartum hemorrhage 7.15 (95% confidence interval, 6.16-8.32). The area under the curve for the model was 0.833. CONCLUSION Peripartum hysterectomy is a relatively common event that hospitals providing routine obstetric care should be prepared to manage. That specific risk factors are highly associated with risk for hysterectomy supports routine use of hemorrhage risk-assessment tools. However, given that a significant proportion of hysterectomies will be unpredictable, the availability of rapid transfusion protocols may be necessary for hospitals to safely manage these cases.
Collapse
Affiliation(s)
- Alexander M Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Zainab Siddiq
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
43
|
Campbell SM, Corcoran P, Manning E, Greene RA. Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland. Eur J Obstet Gynecol Reprod Biol 2016; 207:56-61. [PMID: 27825028 DOI: 10.1016/j.ejogrb.2016.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/05/2016] [Accepted: 10/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The incidence of peripartum hysterectomy (PH) shows fifty-fold variation worldwide (0.2-10.5/1000 deliveries) and risk factors include advancing maternal age and parity, previous caesarean section (CS) and abnormal placentation. OBJECTIVES In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend in PH incidence over 15 years since 1999; to assess risk of PH associated with morbidly adherent placenta (MAP), placenta praevia and postpartum haemorrhage (PPH) during 2005-2013; and to describe the causes, interventions and outcomes of PH cases during 2011-2013. STUDY DESIGN For the 15-year time-trend analysis, PH cases and denominator data were extracted from Ireland's Hospital In-Patient Enquiry database. Multivariate Poisson regression analysis assessed risk of PH associated with MAP, placenta praevia and PPH. In collaboration with the 20 Irish maternity units we carried out a three-year national clinical audit of severe maternity morbidity. PH was a notifiable morbidity and the audit included detailed review of MOH cases. RESULTS In 1999-2013 there were 298 PH cases, a rate of 0.32/1000 deliveries. During the period 2005-2013, the PH rate was 50 times higher in deliveries involving PPH, 100 times higher with placenta praevia and 1000 times higher with MAP. During the clinical audit (2011-2013) there were 65 PH cases, a rate of 0.33/1000 deliveries, increasing with advancing age and parity. The reporting of abnormal placentation, primarily the co-occurrence of placenta praevia and MAP, was linked with previous CS. Fifty-six of the 65 cases suffered MOH, most commonly associated with placenta praevia, MAP and uterine atony. Prophylactic and therapeutic uterotonic agents were appropriately used in the majority of cases. CONCLUSIONS The incidence of PH in Ireland has been consistently low over 15 years, averaging one case every 3000 deliveries. The recognised risk factors of MAP, placenta praevia and PPH were independently associated with PH, with MAP being by far the strongest predictor. The vast majority of PH cases in our clinical audit were associated with MOH. Some deficiencies were noted in antenatal care, in certain elements of treatment and clinical governance protocols but adherence to guidelines was generally high.
Collapse
Affiliation(s)
- Sarah M Campbell
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland
| | - Edel Manning
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
| | -
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland
| |
Collapse
|
44
|
Abstract
BACKGROUND Studies have shown that cesarean delivery is associated with fewer subsequent births relative to vaginal delivery, but it is unclear whether confounding by pregnancy intention or indication for surgery explained these results. We evaluated the association between cesarean delivery and subsequent fecundability among 910 primiparous women after singleton live birth. METHODS In a cohort of Danish women planning pregnancy (2007-2012), obstetrical history was obtained via registry linkage; time-to-pregnancy and covariate data were collected via questionnaire. Fecundability ratios (FRs) and 95% confidence intervals (CIs) were adjusted for potential confounders. RESULTS Relative to spontaneous vaginal delivery, emergency cesarean delivery with cephalic presentation showed little association with fecundability (FR = 1.0, 95% CI = 0.83, 1.3), but cesarean delivery with breech presentation (FR = 0.72, 95% CI = 0.53, 0.97) and planned cesarean delivery with cephalic presentation (FR = 0.51, 95% CI = 0.25, 1.0) were associated with reduced fecundability. CONCLUSIONS The cesarean-fecundability association varied by previous fetal presentation and emergency status.
Collapse
|
45
|
Colmorn LB, Krebs L, Langhoff-Roos J. Potentially Avoidable Peripartum Hysterectomies in Denmark: A Population Based Clinical Audit. PLoS One 2016; 11:e0161302. [PMID: 27560802 PMCID: PMC4999193 DOI: 10.1371/journal.pone.0161302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/03/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods We developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009–2012 and made short narratives of all cases. Results The most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies. Conclusion More than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.
Collapse
Affiliation(s)
- Lotte Berdiin Colmorn
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Lone Krebs
- Department of Obstetrics and Gynecology, Holbæk Hospital/University of Copenhagen, Holbæk, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
46
|
Cheng HC, Pelecanos A, Sekar R. Review of peripartum hysterectomy rates at a tertiary Australian hospital. Aust N Z J Obstet Gynaecol 2016; 56:614-618. [DOI: 10.1111/ajo.12519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Hon C. Cheng
- Department of Obstetrics & Gynaecology; Royal Brisbane and Women's Hospital; Queensland Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute; Queensland Australia
| | - Renuka Sekar
- Centre for Advanced Prenatal Care; Royal Brisbane and Women's Hospital; Queensland Australia
| |
Collapse
|
47
|
Timor-Tritsch IE, Monteagudo A, Cali G, El Refaey H, Kaelin Agten A, Arslan AA. Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean delivery scar pregnancy in the early first trimester. Am J Obstet Gynecol 2016; 215:225.e1-7. [PMID: 26899908 DOI: 10.1016/j.ajog.2016.02.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/26/2016] [Accepted: 02/09/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cesarean scar pregnancy (CSP) is a serious complication of pregnancy, which consists of implantation of the gestational sac in the hysterotomy scar. This condition is increasing in frequency and often poses a diagnostic challenge. Its diagnosis is dependent on visual assessment of the uterus on the longitudinal sagittal ultrasound plane. Misdiagnosing a low intrauterine chorionic sac as a CSP, or a true scar pregnancy as an intrauterine pregnancy (IUP), may lead to adverse outcomes including hysterectomy. OBJECTIVE The objective of the study is to describe a sonographic method for the differential diagnosis of CSP vs IUP in early gestation. The current study tests the hypothesis that on a first-trimester ultrasound performed between 5-10 weeks of gestation, the relative location of the center of gestational sac to the midpoint of the uterus along a longitudinal line between the external cervical os and the fundus can be used for early detection of CSPs. STUDY DESIGN This is a retrospective review of electronically archived ultrasound images of IUP and CSP between 5-10 weeks of gestation. A total of 242 ultrasound images were analyzed: 185 cases of normal IUPs (including 128 in anteverted uteri, 31 in retroverted uteri, and 26 IUPs with history of cesarean delivery) and 57 cases of CSPs diagnosed from 2004 through 2015 in a single institution. The following measurements were made for each case: distance from the external cervical os to the uterine fundus, the midpoint axis of the uterus, the distance from the external cervical os to the center of gestational sacs, and the distance from the external cervical os to the most distant edge of the gestational sacs from the cervix. RESULTS The location of the center of the gestational sac relative to the midpoint axis of the uterus between 5-10 weeks of gestation differentiated between IUP and CSP (mean 17.8 vs -10.6 mm, respectively, P = .0001), indicating that most CSPs are located proximally to the midpoint axis of the uterus whereas most normal IUPs are located distally from the midpoint of the uterus. Using location of the center of the gestational sac as a marker of CSPs between 5-10 weeks of gestation yielded the following characteristics of diagnostic accuracy: sensitivity 93.0% and specificity 98.9%. The likelihood ratio of the positive test was 84.5. The likelihood ratio of the negative test was 0.07. CONCLUSION The location of the center of the gestational sac relative to the midpoint axis of the uterus can be used as an easy method for sonographic differentiation of IUP and CSP between 5-10 weeks of gestation.
Collapse
|
48
|
Arab M, Ghavami B, Saraeian S, Sheibani S, Abbasian Azar F, Hosseini-Zijoud SM. Successful Management of Two Cases of Placenta Accreta and a Literature Review: Use of the B-Lynch Suture and Bilateral Uterine Artery Ligation Procedures. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e35006. [PMID: 27354921 PMCID: PMC4921213 DOI: 10.5812/ircmj.35006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/09/2016] [Accepted: 02/29/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Placenta accreta is an increasingly common complication of pregnancy that can result in massive hemorrhage. CASE PRESENTATION We describe two cases of placenta accreta, with successful conservative management in a referral hospital in Tehran, Iran. In both cases, two procedures were performed: compression suture (B-Lynch) and a perfusion-decreasing procedure (bilateral uterine artery ligation). We also present the results of a narrative literature review. CONCLUSIONS The double B-Lynch and uterine arterial ligation procedure in cases of abnormal placentation might be strongly considered in fertility preservation, coagulopathy, coexisting medical disease, blood access shortage, low surgical experience, distant local hospitals, and no help.
Collapse
Affiliation(s)
- Maliheh Arab
- Department of Gyneco-oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Department of Medical Education, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Maliheh Arab, Department of Gyneco-oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Fax: +98-2177543634, E-mail:
| | - Behnaz Ghavami
- Department of Obstetrics and Gynecology Shariati Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Samaneh Saraeian
- Department of Gyneco-oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Samaneh Sheibani
- Department of Gyneco-oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Abbasian Azar
- Department of Gyneco-oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | |
Collapse
|
49
|
Pacheco LD, Saade GR, Costantine MM, Clark SL, Hankins GDV. An update on the use of massive transfusion protocols in obstetrics. Am J Obstet Gynecol 2016; 214:340-4. [PMID: 26348379 DOI: 10.1016/j.ajog.2015.08.068] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/14/2015] [Accepted: 08/31/2015] [Indexed: 12/16/2022]
Abstract
Obstetrical hemorrhage remains a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the protein C and fibrinolytic pathways. New strategies in hemorrhage treatment include the use of hemostatic resuscitation, although the optimal ratio to administer the various blood products is still unknown. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid-based resuscitation. The evidence behind hemostatic resuscitation has changed in the last few years, and debate is ongoing regarding optimal transfusion strategies. The use of tranexamic acid, fibrinogen concentrates, and prothrombin complex concentrates has emerged as new potential alternative treatment strategies with improved safety profiles.
Collapse
Affiliation(s)
- Luis D Pacheco
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX; Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX.
| | - George R Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Steven L Clark
- Department of Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Gary D V Hankins
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX
| |
Collapse
|
50
|
Dahm-Kähler P, Diaz-Garcia C, Brännström M. Human uterus transplantation in focus. Br Med Bull 2016; 117:69-78. [PMID: 26888381 DOI: 10.1093/bmb/ldw002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Uterus transplantation (UTx) is introduced as the first treatment for absolute uterine factor infertility (AUFI), affecting 1:500 fertile aged women. This review presents potential patients, research and human UTx cases. SOURCES OF DATA Published articles and our research experience. AREAS OF AGREEMENT The first UTx live births in 2014 established UTx as a possible treatment for AUFI. This was proceeded by 15 years of systematic research. AREAS OF CONTROVERSY Is a deceased donor UTx as effective as the proven successful live donor UTx?. GROWING POINTS Human UTx trials will accumulate data on risks, effectiveness and long-term consequences for donors, recipients and children. These should also include aspects of quality of life, psychological well-being and cognitive/neuropsychiatric development of children. AREAS TIMELY FOR DEVELOPING RESEARCH All new activities in human UTx within the coming years should be conducted as prospective observational studies, and data should also be collected within an international registry.
Collapse
Affiliation(s)
- Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Cesar Diaz-Garcia
- Department of Obstetrics and Gynecology, La Fe University Hospital, University of Valencia, 46026 Valencia, Spain
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden Stockholm IVF, 12063 Stockholm, Sweden
| |
Collapse
|