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Ma G, Yang Y, Fu Q. The incidence, indications, risk factors and pregnancy outcomes of peripartum hysterectomy at a tertiary hospital between 2013 and 2022. Arch Gynecol Obstet 2024; 310:145-151. [PMID: 37966518 DOI: 10.1007/s00404-023-07276-2] [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: 07/07/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To analyze the incidence, indications, risk factors and pregnancy outcomes of postpartum hemorrhage resulting in peripartum hysterectomy (PH). METHODS We retrospectively reviewed patients with postpartum hemorrhage requiring surgical procedures at ≥ 28 weeks of gestation from January 1, 2013 to December 31, 2022 at a tertiary hospital in Shanghai, China. The patients were divided into a PH group and a non-PH group. Maternal clinical characteristics, the management of postpartum hemorrhage, pregnancy outcomes were compared between groups. Logistic regression was used to analyze the correlations between risk factors and PH. RESULTS The incidence of hysterectomy was 0.2/1000 deliveries (31/150194). The variables significantly associated with PH were placenta previa with placenta increta/percreta (OR36.26), uterine rupture (OR266.16) and an estimated blood loss ≥ 3513 mL (OR431.11). The proportion of cases involving hemorrhagic shock, disseminated intravascular coagulation, bladder injury, neonatal severe asphyxia, neonatal death and hypoxic-ischemic encephalopathy were significantly higher in the PH group (P < 0.05). CONCLUSION The most common indications of PH were placental pathology. Efforts should be made to reduce the rate of cesarean deliveries and uterine curettage to lower the probability of abnormal placental invasion and appropriate medical indications for trial of labor after cesarean should be strictly followed to avoid the risk of uterine rupture.
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Affiliation(s)
- Guojun Ma
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China
| | - Yi Yang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China
| | - Qin Fu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China.
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Xie J, Lu X, Liu M. Clinical analysis of complete uterine rupture during pregnancy. BMC Pregnancy Childbirth 2024; 24:255. [PMID: 38589817 PMCID: PMC11000347 DOI: 10.1186/s12884-024-06394-2] [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: 09/16/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Uterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture. METHODS Data from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People's Hospital between January 2015 and December 2022 were analyzed retrospectively. RESULTS In total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1-40+3 weeks), and the average bleeding volume was 1896.97 ml (200-6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%). CONCLUSIONS The site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.
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Affiliation(s)
- Jing Xie
- The Chenzhou No.1 People's Hospital, Chenzhou, 423000, China
- The First Affiliated Hospital of Xiangnan University, Chenzhou, 423000, China
| | - Xuefang Lu
- Department of Radiology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, China.
| | - Miao Liu
- The Chenzhou No.1 People's Hospital, Chenzhou, 423000, China
- The First Affiliated Hospital of Xiangnan University, Chenzhou, 423000, China
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Xie D, Wei J, Wang A, Xiong L, Zou K, Xie Z, Fang J. The effect of China's many-child policy on the number of births and the prevalence of serious teratogenic and disabling defects in Hunan Province. BMC Public Health 2023; 23:2226. [PMID: 37951872 PMCID: PMC10640731 DOI: 10.1186/s12889-023-16583-x] [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: 11/15/2022] [Accepted: 08/22/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND To research the effect of China's many-child policy on the number of births and the prevalence of serious teratogenic and disabling defects (STDDs) in Hunan province. METHODS We performed an observational study based on the Birth Defect (BD) Surveillance System of Hunan Province and chose STDD case cards. From 2012-2022, we defined the following 4 periods: the one-child policy (OCP) (2012.01-2013.12), partial two-child policy (PTCP) (2014.1-2015.12), universal two-child policy (UTCP) (2016.1-2020.12), and the early stage of the three-child policy (ETCP) (2021.1-2022.12). Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the association of policy changes with STDDs. Crame'r's V was calculated to estimate the effect sizes. Joinpoint regression analysis and annual percent change (APC) were used for each segment of the trend. RESULTS A total of 1,652,079 births were included in this analysis. Joinpoint regression analysis showed that the number of perinatal births increased from 2012 to 2017, with APC = 9.52 (95% CI: 7.2 to 11.8), and decreased from 2017 to 2022, with an APC = -10.04 (95% CI: -11.9 to -8.1). The number of mothers over 30 years old gradually increased, from 25.54% during the OCP period to 54.05% during the ETCP period (Ptrend < 0.001). With policy changes, the total prevalence of STDDs increased from 28.10 per 10,000 births during the period of OCP into 46.77 per 10,000 births during the ETCP period by 66.44%. The live birth prevalence of STDDs increased only during the ETCP period (PTCP: OR = 1.27, 95% CI: 0.99-1.24, p = 0.057, UTCP: OR = 1.22, 95% CI: 0.99-1.52, p = 0.067, ETCP: OR = 1.75, 95% CI: 1.37-2.24, p < 0.001). Over the past ten years, there was a decrease in the gestational age at diagnosis (*F = 772.520, p < 0.001), from 24.49 ± 5.65 weeks in 2012 to 20.77 ± 5.17 weeks in 2022. From 2012 to 2022, the percentage of deaths within 7 days decreased with APC = -18.85 (95% CI: -26.4- -10.5, P > 0.05). CONCLUSION Many-child policies were associated with a moderate increase in fertility especially for women in urban areas and older women. However, they have lost the ability to control birth since 2017. The total prevalence of STDDs increased over the entire period, but the live birth prevalence increased only during the ETCP period. The gestational age at diagnosis decreased and the percentage of deaths within 7 days decreased.
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Affiliation(s)
- Donghua Xie
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
- NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital), 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Jianhui Wei
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Aihua Wang
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Lili Xiong
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Kehan Zou
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Zhiqun Xie
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
| | - Junqun Fang
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
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Tinelli A, Kosmas IP, Carugno JT, Carp H, Malvasi A, Cohen SB, Laganà AS, Angelini M, Casadio P, Chayo J, Cicinelli E, Gerli S, Palacios Jaraquemada J, Magnarelli G, Medvediev MV, Metello J, Nappi L, Okohue J, Sparic R, Stefanović R, Tzabari A, Vimercati A. Uterine rupture during pregnancy: The URIDA (uterine rupture international data acquisition) study. Int J Gynaecol Obstet 2021; 157:76-84. [PMID: 34197642 DOI: 10.1002/ijgo.13810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients. METHODS Demographic information, surgical history, symptoms, and postoperative outcome of women and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in women with previous UR. RESULTS Uterine rupture was significantly associated with previous uterine surgery, occurring, on average, at 36 weeks of pregnancy in women also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to UR. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several women. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy. CONCLUSION Data analysis showed that previous laparoscopic and abdominal myomectomies were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contraindication to future pregnancies.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy.,Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy.,Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.,Department of Obstetrics and Gynecology, Veris delli Ponti Hospital, Scorrano & Vito Fazzi Hospital, Lecce, Italy
| | - Ioannis P Kosmas
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.,Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Hatzikosta, University of Ioannina, Ioannina, Greece
| | - Jose Tony Carugno
- MIGS/Robotics Division Director, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Howard Carp
- Department of Obstetrics and Gynecology, Sheba Medical Center, TLV University, Tel Hashomer, Israel
| | - Antonio Malvasi
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.,Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, TLV University, Tel Hashomer, Israel
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Marta Angelini
- Department of Obstetrics and Gynecology, Medical School, University of Udine, Udine, Italy
| | - Paolo Casadio
- Department of Obstetrics and Gynecology, Medical School, University of Bologna, Bologna, Italy
| | - Jenifer Chayo
- Department of Obstetrics and Gynecology, Sheba Medical Center, TLV University, Tel Hashomer, Israel
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, Medical School, University of Bari, Bari, Italy
| | - Sandro Gerli
- Department of Obstetrics and Gynecology, Medical School, University of Perugia, Perugia, Italy
| | - Josè Palacios Jaraquemada
- Department of Obstetrics and Gynecology, Medical School, University of Buenos Aires, Buenos Aires, Argentina
| | - Giulia Magnarelli
- Department of Obstetrics and Gynecology, Medical School, University of Bologna, Bologna, Italy
| | - Mykhailo V Medvediev
- Department of Obstetrics and Gynecology, University of Dnepropetrovsk medical academy of Health Ministry of Ukraine, Dnepropetrovsk, Ukraine
| | - Josè Metello
- Centro de Infertilidade e Reprodução Medicamente Assistida, Hospital Garcia de Orta, Almada, Portugal
| | - Luigi Nappi
- Department of Obstetrics and Gynecology, Medical School, University of Foggia, Foggia, Italy
| | - Jude Okohue
- Department of Obstetrics and Gynecology, Madonna University Teaching Hospital, Port Harcourt, Nigeria
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Radomir Stefanović
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Avinoam Tzabari
- Department of Obstetrics and Gynecology, Hospital Mayane Hayeshua Medical Center, Bnei Brak, Israel
| | - Antonella Vimercati
- Department of Obstetrics and Gynecology, Medical School, University of Bari, Bari, Italy
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