Emergency hysterectomy for life-threatening postpartum haemorrhage: Risk factors and psychological impact

Michelet, D.; Ricbourg, Aude; Gosme, Christelle; Rossignol, Mathias; Schurando, Patrick; Barranger, Emmanuel; Mebazaa, Alexandre; Gayat, Étienne

doi:10.1016/j.gyobfe.2015.10.010

Cited by 32 publications

(38 citation statements)

References 26 publications

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“…[ 22 – 25 ] It has been reported that coagulopathy control is imperative for a successful hysterectomy for PPH. [ 26 – 27 ] Our detailed preoperative and postoperative coagulation function index data for PPH-related hysterectomy revealed that postoperative prothrombin activity increased significantly relative to the midoperation levels in all the women analyzed, except 3 who underwent re-exploration after intra-abdominal bleeding and 2 women who died. In 69 women, conservative measures failed to prevent hysterectomy, resulting in reduced prothrombin activity until the blood loss was adequately controlled.…”

Section: Discussionmentioning

confidence: 99%

Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage

et al. 2017

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“…When hemostasis is difficult to establish despite all the trials including bimanual uterine compression, administration of utero tonic agent, B-Lynch compression sutures, Emergency Hysterectomy is performed to save women from death, placenta accrete is the most common Indication for hysterectomy [40] PPH related hysterectomy was 3.87 times higher in those women who already had a prior C-section than those who didn't have prior C-section [41]. The psychological trauma of not being able to bear a child , loss of fertility and many short term and long term complications such as injury of other organs, poor wound healing, Infection still makes Hysterectomy as the ultimate and the most common procedure to save life and to achieve arrest of bleeding from severe postpartum hemorrhage [42].…”

Section: Hysterectomymentioning

confidence: 99%

An Overview on the Cause and Management of Postpartum Hemorrhage

Khan¹,

Zhu²,

Wang³

2019

IJCRR

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Postpartum hemorrhage is a potentially lethal, hazardous whilst preventable condition making it the significant cause of maternal mortality. It is defined as loss of blood greater than 500ml in a normal delivery and more than 1000ml in C-section in the first 24 hours. One third and one fourth of the death that occurs is due to postpartum hemorrhage, Among the various causes of Postpartum hemorrhage (PPH), uterine atony is the most common cause involved in 80% of the cases. Hypovolemic shock, DIC, hepatorenal syndrome and acute distress syndrome are some of the complications in women who encounter massive postpartum hemorrhage. Death occurs in women in whom timely adequate emergency measures were not taken. Life can be saved when immediate measures are taken. When uterine atony is observed administration of utero tonic drugs such as oxytocin and prostaglandin, uterine massage, uterine compression technique and intrauterine balloon tamponade is used. When hemostasis is not achieved by conservative method then, TAE or surgical management including (vessel ligation, bilateral ligation of the uterine or internal iliac arteries), uterine compression suture, and hysterectomy is implemented in refractive cases without any further delay.

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“…Globally 1 in 1000 women will lose their uterus during child birth through EPH [1,16]. This is mainly due to severe post partum hemorrhage secondary to abnormal placentation (placenta previa or placenta accreta), abruption placenta, uterine atony, ruptured uterus and genital tears [17][18][19] In Sub-Saharan Africa, the incidence of EPH is five times higher than the global average mainly because of high parity, lack of skilled attendance at birth, prolonged and obstructed labor [14,[20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Women’s experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study

Pilli

Sekweyama

Kayira

2020

BMC Pregnancy Childbirth

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Background Emergency peripartum hysterectomy (EPH) is a known remedy for saving women’s lives when faced with the challenging situation of severe post partum hemorrhage not responsive to conservative management. However, EPH by its nature is also a traumatic birth event that causes serious physical, emotional and psychological harm. Unfortunately at St. Francis Hospital Nsambya nothing much is known about these experiences since no study has been undertaken and these women are not routinely followed up. The purpose of this study was to explore these emotional experiences. Methods This was a qualitative phenomenological study carried out between August and December 2018. All those women who had undergone EPH between January 2015 and August 2018 were eligible to participate in the study. Purposive sampling was used. 18 women were interviewed before saturation was reached. All interviews were audio-recorded and then transcribed verbatim. Thematic analysis was used to analyze the data. Results Three major themes were identified as the main experiences of these women in this study and they were; Loss of Womanhood, Joy for being alive and Loss of marital safety. Conclusion Women experience serious emotional consequences following EPH. We recommend routine follow-up to help appreciate these experiences and advise them on appropriate mitigating measures.

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Emergency hysterectomy for life-threatening postpartum haemorrhage: Risk factors and psychological impact

Cited by 32 publications

References 26 publications

Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage

Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage

An Overview on the Cause and Management of Postpartum Hemorrhage

Women’s experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study

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