1
|
Sheth V, Vaishnav S, Sapre S, Bhattacharjee R, Raithatha N, Asrani M. Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India. J Obstet Gynaecol India 2023; 73:206-212. [PMID: 38143980 PMCID: PMC10746675 DOI: 10.1007/s13224-023-01842-z] [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: 10/11/2022] [Accepted: 08/19/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India. Design Retrospective observational and comparative study from single rural tertiary care referral center of western India. Method A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH. Results Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% (p 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% (p 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%(p < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%(p < 0.001) and morbidly adherent placenta increases from 7 to 23%(p 0.007). ICU admission and ventilator support increases from 54 to 79%(p 0.04) and 22% to 70% (p < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% (p 0.5). Conclusion Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.
Collapse
Affiliation(s)
- Vishal Sheth
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Smruti Vaishnav
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Shilpa Sapre
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Rumi Bhattacharjee
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Nitin Raithatha
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Manisha Asrani
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| |
Collapse
|
2
|
Vural T, Bayraktar B, Karaca SY, Golbasi C, Odabas O, Taner CE. Indications, risk factors, and outcomes of emergency peripartum hysterectomy: A 7-year retrospective study at a tertiary center in Turkey. Malawi Med J 2023; 35:31-42. [PMID: 38124696 PMCID: PMC10645903 DOI: 10.4314/mmj.v35i1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Objective To determine the incidence, indications, the risk factors, complications, maternal morbidity and mortality of emergency peripartum hysterectomy (EPH), and perinatal outcomes at a tertiary hospital, Turkey. Methods We analyzed 71 cases of EPH from 2012 to 2019 at a tertiary hospital in a retrospective study. There were 142 control patients. Results There were 71 EPH out of 69,504 deliveries, for an overall incidence of 1.02 per 1000 births. The main indication for peripartum hysterectomy was abnormal placentation (67.6%), followed by uterine atony (28.1%), and uterine rupture (4.2%). Cesarean section (CS) and previous CS are major risk indicators for EPH. Other risk indicators are advanced maternal age (≥ 35 years) and multiparity. All patients with abnormal placentation had a previous CS. 93% of EPH were performed during and/or after CS, and 7% after vaginal delivery. 69% of EPH were made in total and 31% were subtotal. The three most common maternal morbidity included: wound infection and febrile morbidity (26.7%), bladder injury (16.9%), and disseminated intravascular coagulopathy (11.2%). There were no maternal deaths but perinatal mortality was 4%. Conclusion The most common indication for EPH was abnormal placentation. Also, CS and previous CS are major risk factors of EPH. Other risk factors for EPH are advanced maternal age (≥ 35 years) and multiparity. Moreover, all unnecessary CS should be avoided.
Collapse
Affiliation(s)
- Tayfun Vural
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Suna Yildirim Karaca
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Ceren Golbasi
- Department of Obstetrics and Gynecology, Izmir Tinaztepe University Faculty of Medicine, Turkey
| | - Ozan Odabas
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| | - Cuneyt Eftal Taner
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Turkey
| |
Collapse
|
3
|
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
|
4
|
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
|
5
|
Pettersen S, Falk RS, Vangen S, Nyfløt LT. Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital-based study. Acta Obstet Gynecol Scand 2022; 101:819-826. [PMID: 35388907 DOI: 10.1111/aogs.14358] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies. MATERIAL AND METHODS Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy. RESULTS The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications). CONCLUSIONS The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications.
Collapse
Affiliation(s)
- Silje Pettersen
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lill T Nyfløt
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics, Drammen Hospital, Drammen, Norway
| |
Collapse
|
6
|
The impact of a multilevel approach to reduce emergency hysterectomy for postpartum haemorrhage: insights from a tertiary referral centre in Northern Italy. Eur J Obstet Gynecol Reprod Biol 2022; 271:152-157. [DOI: 10.1016/j.ejogrb.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
|
7
|
Jamshed S, Chien SC, Tanweer A, Asdary RN, Hardhantyo M, Greenfield D, Chien CH, Weng SF, Jian WS, Iqbal U. Correlation Between Previous Caesarean Section and Adverse Maternal Outcomes Accordingly With Robson Classification: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:740000. [PMID: 35096855 PMCID: PMC8795992 DOI: 10.3389/fmed.2021.740000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The increasing rates of Caesarean section (CS) beyond the WHO standards (10–15%) pose a significant global health concern. Objective: Systematic review and meta-analysis to identify an association between CS history and maternal adverse outcomes for the subsequent pregnancy and delivery among women classified in Robson classification (RC). Search Strategy: PubMed/Medline, EbscoHost, ProQuest, Embase, Web of Science, BIOSIS, MEDLINE, and Russian Science Citation Index databases were searched from 2008 to 2018. Selection Criteria: Based on Robson classification, studies reporting one or more of the 14 adverse maternal outcomes were considered eligible for this review. Data Collection: Study design data, interventions used, CS history, and adverse maternal outcomes were extracted. Main Results: From 4,084 studies, 28 (n = 1,524,695 women) met the inclusion criteria. RC group 5 showed the highest proportion among deliveries followed by RC10, RC7, and RC8 (67.71, 32.27, 0.02, and 0.001%). Among adverse maternal outcomes, hysterectomy had the highest association after preterm delivery OR = 3.39 (95% CI 1.56–7.36), followed by Severe Maternal Outcomes OR = 2.95 (95% CI 1.00–8.67). We identified over one and a half million pregnant women, of whom the majority were found to belong to RC group 5. Conclusions: Previous CS was observed to be associated with adverse maternal outcomes for the subsequent pregnancies. CS rates need to be monitored given the prospective risks which may occur for maternal and child health in subsequent births.
Collapse
Affiliation(s)
- Shazia Jamshed
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Malaysia.,Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
| | - Shuo-Chen Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Afifa Tanweer
- Department of Nutrition Sciences, School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Rahma-Novita Asdary
- Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Hardhantyo
- Graduate Program of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Faculty of Health Science, Universitas Respati Yogyakarta, Depok, Indonesia.,Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Depok, Indonesia
| | - David Greenfield
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales (UNSW) Medicine, Sydney, NSW, Australia.,Linéaire Projects, Sydney, NSW, Australia
| | - Chia-Hui Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Office of Public Affairs, Taipei Medical University, Taipei, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Shan Jian
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,School of Health Care Administration, School of Gerontology Health Management, Graduate Institute of Data Science, Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program in Depatment of Global Health & Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
8
|
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
|
9
|
Yildirim GY, Koroglu N, Akca A, Talmac M, Dikmen S, Yıldırım G, Polat I, Ozdemir I. What is new in peripartum hysterectomy? A seventeen year experience in a tertiary hospital. Taiwan J Obstet Gynecol 2021; 60:95-98. [PMID: 33495017 DOI: 10.1016/j.tjog.2020.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify changing trends in peripartum hysterectomy (PH), both elective. cesarean hysterectomy and emergency cesarean hysterectomy, at a single training and research hospital over the last 17 years in Istanbul, Turkey. MATERIALS AND METHODS A retrospective cohort study was performed between January 2001 and September 2017. The records of all patients who had PH at Kanuni Sultan Süleyman Training and Research Hospital were analyzed. RESULTS There were 243 cases of PH during the study period. A total of 266,386 births occurred, of which 60.1% were vaginal deliveries and 39.8% were cesarean sections. The incidence of PH increased from 0.67 per 1000 deliveries to 1.14 per 1000 deliveries during 2001-2008 and 2009-2017, respectively, with an overall incidence of 0.91 per 1000 deliveries during the 17 years. The main indication for PH changed significantly during this time from uterine atony (57.1%) to placenta accreta spectrum (85%). About 37% of women who underwent PH had at least one previous cesarean delivery during 2001-2008, whereas that percentage increased to 95.4% during 2009-2017. CONCLUSION Placenta accreta spectrum was the leading cause of PH and was associated with significant maternal morbidity and mortality.
Collapse
Affiliation(s)
- Gonca Yetkin Yildirim
- Istanbul Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Nadiye Koroglu
- Istanbul Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Aysu Akca
- Istanbul Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Merve Talmac
- Istanbul Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Selin Dikmen
- Istanbul Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Gokhan Yıldırım
- Medipol University Faculty of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Ibrahim Polat
- Istanbul Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Ismail Ozdemir
- Istanbul Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| |
Collapse
|
10
|
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
|
11
|
Chaudhary V, Singh M, Nain S, Reena F, Aggarwal K, Biswas R, Puri M, Pujari J. Incidence, Management and Outcomes in Women Undergoing Peripartum Hysterectomy in a Tertiary Care Centre in India. Cureus 2021; 13:e14171. [PMID: 33936882 PMCID: PMC8080949 DOI: 10.7759/cureus.14171] [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] [Accepted: 03/29/2021] [Indexed: 01/28/2023] Open
Abstract
Background Peripartum hysterectomy (PRH) is the surgical removal of the uterus performed in obstetrical complications such as uncontrolled postpartum haemorrhage (PPH), unrepairable uterine rupture, and sepsis. Its incidence has increased in recent years. The objective of this study was to review all the cases of PRH in a tertiary care teaching hospital over three years (January 2017-December 2019) to determine its incidence and analyse clinico-demographic characteristics in these women. Method All women undergoing PRH from January 2017 to December 2019 were included in the study. Data were collected retrospectively from medical records, of patients who underwent a PRH at the time of delivery, or within 24 hours, or performed any time before discharge from the same hospitalization and obstetric event. The total number of deliveries including caesarean and vaginal deliveries were recorded. Main outcome measures were the incidence of PRH, indication for hysterectomy, management option used, maternal outcomes (PPH, bladder injury and maternal death) and fetal outcomes (stillbirth). Results There were a total of 3904,4 deliveries; 27,337 vaginal and 11,697 caesarean sections in three years. A total of 50 patients underwent a PRH. The incidence of PRH in our study was 1.3 per 1,000 deliveries and 3.5/1,000 caesareans, respectively. PRH was found to be more common following cesarean sections than vaginal deliveries (odds ratio 22.86 [95% CI: 8.16 to 63.98]). Morbid adherent placenta (MAP) (n=30, 62%) was the most common indications of PRH. Seven (15%) women had PRH due to uterine rupture. Twenty-seven women of the 30 women (90%) with the MAP had a previous caesarean delivery. The case fatality rate per hysterectomy was 4%. Stillbirth rate (SBR: n=8,16%) among women having PRH was seven-fold higher than overall SBR in our country. Conclusion There has been a rise in MAP as an indication of PRH in our study for a decade in comparison to uterine atony. Caesarean delivery is a significant risk factor for PRH. Previous caesarean section and major placenta previa were common occurring obstetric risk factors present in the MAP in our cohort. Our maternal mortality in PRH was low and the stillbirth rate was high when compared with national data.
Collapse
Affiliation(s)
- Vidhi Chaudhary
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Meenakshi Singh
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Shilpi Nain
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Fnu Reena
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Kiran Aggarwal
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Ratna Biswas
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Manju Puri
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Janithya Pujari
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| |
Collapse
|
12
|
Old and novel insights into emergency peripartum hysterectomy: a time-trend analysis. Arch Gynecol Obstet 2020; 301:1159-1165. [PMID: 32221710 DOI: 10.1007/s00404-020-05504-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess changing trends, role of the triad patient-pregnancy-health professionals and health care cost in emergency peripartum hysterectomy (EPH). METHODS Demographics, indications, perinatal outcomes, perioperative complications in EPH cases performed in a 10-year period were extracted from the local birth registry. Experience of health professionals in the management of the post-partum haemorrhage was valued. Two subgroups (Period I, 2009-2013 vs. Period II, 2014-2018) were recognized. Overall and detailed EPH ratios/1000 deliveries were calculated. Cost analysis was achieved in agreement with the diagnosis-related group (DGR) system. RESULTS A total of 39 EPH were performed among 36,053 deliveries. EPH incidence increased from 0.8 to 1.32‰ across study periods (p < 0.001). The mean maternal age (36.9 ± 4.7 vs. 38.9 ± 5.9 years, p = 0.035) and the high socio-economic status (0 vs. 19.2%, p = 0.027) were statistically different. Multiparity (84.6 vs. 96.2%, p = 0.005), previous caesarean section (CS) (0.9 ± 0.9 vs. 1.2 ± 1.6, p = 0.049), and emergent CS (7.7 vs. 19.2%, p = 0.048) were found statistically different. In Period II, increased attempts in conservative approaches (7.7 vs. 36.8%, p = 0.007), reduction in blood loss (3184 ± 1753 vs. 2511 ± 1252 mL, p = 0.045), advanced age of gynecologists performing EPH (54.5 ± 9.2 vs. 60.3 ± 6.4 years, p = 0.024), and augmented health care costs (mean DRG of € 2.782 vs. 3.371,95, p < 0.001) were observed. CONCLUSIONS As a "near-miss" event, advances on identification of EPH factors are mandatory. Time-trend analyses might add information and address novel strategies.
Collapse
|
13
|
Lauroy A, Verhaeghe C, Vidal F, Parant O, Legendre G, Guerby P. Perioperative outcomes using LigaSure compared with conventional technique in peripartum hysterectomy. Arch Gynecol Obstet 2019; 301:229-234. [DOI: 10.1007/s00404-019-05398-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022]
|
14
|
Chen L, Wu B, Han Q, Yan J. Clinical analysis of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage. J Int Med Res 2019; 48:300060519879294. [PMID: 31662015 PMCID: PMC7607188 DOI: 10.1177/0300060519879294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study was performed to explore the causes and clinical characteristics
of emergency exploratory laparotomy in patients with intractable postpartum
hemorrhage. Methods This retrospective study was performed from January 2004 to December 2017.
Patients with intractable postpartum hemorrhage were grouped according to
the initial pathogenesis as determined by exploratory laparotomy: uterine
atony, placental factors, coagulation dysfunction, or uterine rupture. Results This study involved 72 patients who underwent emergency exploratory
laparotomy, accounting for 0.04% of total deliveries. Uterine preservation
surgery and hysterectomy were performed in 31 and 41 patients, respectively.
Abnormal events upon returning to the ward were primarily vaginal hemorrhage
and pelvic hematoma. The frequency of uterine artery ligation was lower in
the hysterectomy group than uterine preservation group. The prothrombin
activity level, fibrinogen level, and platelet count before surgery were
lower in the hysterectomy group than uterine preservation group. The
international normalized ratio and activated partial thromboplastin time
were higher in the hysterectomy group than uterine preservation group. In
total, 44 patients developed complications. Conclusion Placental implantation is a primary cause of hysterectomy after emergency
laparotomy. However, the possibility of postpartum hemorrhage caused by
coagulation disorders should not be ignored.
Collapse
Affiliation(s)
- Lichun Chen
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Baohua Wu
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Qing Han
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Jianying Yan
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| |
Collapse
|
15
|
Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Dell'Oro S, Donati S. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population-based study. Acta Obstet Gynecol Scand 2019; 99:274-282. [PMID: 31520414 DOI: 10.1111/aogs.13727] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is usually undertaken in cases of life-threatening obstetric hemorrhage to prevent the death of the mother. Near-miss events are still under-researched and inappropriate care continues to be a critical issue, even in countries with advanced obstetric surveillance systems. The aim of the present study was to estimate the prevalence, associated factors, management and intraoperative and postoperative complications of peripartum hysterectomy due to obstetric hemorrhage. MATERIAL AND METHODS A prospective population-based study has been conducted in six Italian regions covering 49% of births in Italy. The study population comprised all women aged 11-59 years undergoing peripartum hysterectomy, from September 2014 to August 2016, due to obstetric hemorrhage within 7 days of delivery. In each maternity unit a trained reference person reported incident cases using electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. RESULTS The overall peripartum hysterectomy prevalence was 1.09 per 1000 maternities, with a large variability among regions, ranging from 0.52 to 1.60. Previous cesarean section (relative risk [RR] 4.97, 95% CI 4.13-5.96), assisted reproductive technology (RR 5.99, 95% CI 4.42-8.11) multiple pregnancy (RR 5.03, 95% CI 3.57-7.09) and maternal age ≥35 years (RR 2.69, 95% CI 2.25-3.21) were the main associated factors for hysterectomy. The most common causes of peripartum hysterectomy were uterine atony (45.1%) and abnormally invasive placentation (40.2%). Intensive care unit admission was reported in 49.9% of cases, 16.8% of women suffered severe morbidity and 5 women died. CONCLUSIONS The rate of peripartum hysterectomy in Italy was three times higher compared with the UK, the Netherlands and the Nordic countries. The wide difference may be associated with women's characteristics, such as age at delivery and previous cesarean section, and with different management options leading to peripartum hysterectomy.
Collapse
Affiliation(s)
- Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Marta Buoncristiano
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Stefania Dell'Oro
- Department of Obstetrics and Gynecology, Foundation MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | | |
Collapse
|
16
|
|
17
|
Barinov SV, Medjannikova IV, Tirskaya YI, Chuprinin VD, Khilkevich EG, Savelyeva IV, Shamina IV, Borisova AV, Lazareva OV. The use of Zhukovsky vaginal and intrauterine balloons to improve the outcome of postpartum hysterectomies in patients with severe bleeding. J Matern Fetal Neonatal Med 2019; 33:2955-2960. [PMID: 30614315 DOI: 10.1080/14767058.2019.1566309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: To assess the efficacy of a Zhukovsky obstetric double balloon for improving outcomes in women undergoing hysterectomy for postpartum hemorrhage.Materials and methods: This was a randomized controlled study. Participants were divided into two groups to undergo insertion of a Zhukovsky obstetric double balloon prior to hysterectomy (n = 16) or conventional hysterectomy (n = 25).Results: The main reasons for major obstetric hemorrhage were placenta accreta (53.6%), uterine atony (26.8%), uteroplacental apoplexy (14.6%), and amniotic fluid embolism (4.8%). The use of a Zhukovsky obstetric double balloon during postpartum hysterectomy was associated with a 1.7-fold reduction in blood loss and a 2.3-fold reduction in blood loss > 2000 ml compared with conventional hysterectomy.Conclusion: The use of a Zhukovsky obstetric double balloon represents a potent tool for improvement of immediate outcomes of hysterectomy in women with severe postpartum bleeding.
Collapse
Affiliation(s)
- Sergey V Barinov
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Irina V Medjannikova
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Yuliya I Tirskaya
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Vladimir D Chuprinin
- Ministry of Health of Russia, National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Elena G Khilkevich
- Ministry of Health of Russia, National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Irina V Savelyeva
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Inna V Shamina
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Anna V Borisova
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| | - Oksana V Lazareva
- Russian Ministry of Health, Federal State Budget Educational Institution of Higher Education Omsk State Medical University, Omsk, Russia
| |
Collapse
|
18
|
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
|