Analysis of 59 cases of emergent peripartum hysterectomies during a 13-year period

OBJECTIVE

The objective was to investigate the incidence, indications, and risk factors of peripartum emergent hysterectomy.

METHOD

Fifty-nine cases of emergent peripartum hysterectomy performed at Zeynep Kamil Women and Children's Education and Research Hospital during a 13-year period between January 1990 and January 2003 were evaluated retrospectively. Emergent peripartum hysterectomy was defined as that performed for haemorrhage unresponsive to other therapeutic interventions within the first 24 h of delivery.

RESULT

Emergent peripartum hysterectomy was performed in 59 cases of 234,958 women (25.1/100,000). Total and subtotal hysterectomy was performed in 25 and 34 cases respectively. The rates of emergent peripartum hysterectomy after vaginal and caesarean deliveries were 8.7/100,000 and 104.5/100,000 respectively. Uterine atony was the most frequent indication (62.7%). The rates of emergent peripartum hysterectomy due to uterine atony in primiparous and multiparous women were 61.1 and 65.2% respectively. The rate of maternal mortality was 8% (5 cases).

CONCLUSION

Uterine atony was the most common indication for emergent peripartum hysterectomy.

Stromomyomas of the uterus-- importance of total circumferential evaluation of the margin

Four stromomyomas were extensively dissected to represent the entire circumference of the uterus on sequential histologic sections. In all cases the smooth muscle component was extensive, and irregular interdigitation of stromal neoplasia with a smooth muscle component made evaluation of the margin difficult. It was impossible to determine where the smooth muscle component of the neoplasm ended and where peritumoral normal myometrium began. This makes the detection of vascular invasion more important. At the end of a thorough evaluation of sections, large vessel invasion was found on the circumference of three stromomyomas in a particular foci of the margin. Extensive circumferential evaluation of the margin has been evaluated as a promising procedure to allow effective distinction of stromomyomas with focal angioinvasion.