Emergency peripartum hysterectomy: a 9-year review

Yücel, Oğuz; Özdemir, İsmail; Yücel, Neşe; Somunkiran, Aslı

doi:10.1007/s00404-006-0124-4

Cited by 90 publications

(129 citation statements)

References 20 publications

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“…In comparison with Smith's 6%, Kwee's 15%, Yucel's 8.8%, Zeteroglu's 12.5%, and Zelop's 9%, our urinary tract injury rate is 7.7%. [2,10,17,26,27] Reexploration was performed in 1 case (7.7%) for persistent postoperative bleeding, compared with Smith's 11%, Kwee's 25%, Zeteroglu's 12.5%, and Ozden's 6.8% [2,10,17,24]. In our series, 4 women (30.7%) developed disseminated intravascular coagulopathy, lower than the 33% rate previously reported by Smith and Mousa and Lau et al [17,22].…”

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confidence: 48%

Emergency Peripartum Hysterectomy: A 10-Year Review

Carvalho

Cubal

Torres

et al. 2012

ISRN Emergency Medicine

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Background. Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Purpose. To determine the incidence, risk factors, indications, outcomes, and complications of EPH performed in a tertiary teaching hospital and to compare the results with other reports in the literature. Methods. The medical records of 13 patients who had undergone EPH, between January 2000 and December 2010, were reviewed retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results. There were 13 EPHs out of 31.767 deliveries, a rate of 0.41 per 1,000 deliveries. Eight hysterectomies were performed after cesarean delivery and five after vaginal delivery. The most common indication for hysterectomy was uterine atony (10/13), followed by placenta previa (2/13). There were one case of intraoperative bladder injury and one case of relaparotomy because of hemoperitoneum. We had one maternal death because of septic shock. There were no cases of neonatal morbidity and mortality. Conclusion. Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face. IntroductionEmergency peripartum hysterectomy (EPH) is an uncommon obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. [1][2][3] It was first proposed in 1869 but with no desirable results [4]. However, seven years later (1876), the first cesarean subtotal hysterectomy was carried out successfully, with the result that both the mother and the baby survived [5]. In modern obstetrics, the overall incidence of EPH is 0.05%, but there are considerable differences in incidence in different parts of the world, depending on modern obstetric services, standards and awareness of antenatal care, and the effectiveness of family planning activities of a given community [6]. The incidence of peripartum hysterectomy in the literature is reported as 0.24, 0.77, 2.3, and 5.09 per 1,000 deliveries by Sakse et al. [7], Whiteman et al. [8], Bai et al. [9] and Zeteroglu et al. [10], respectively. However, there is a lack of Portuguese data on EPH. To our knowledge, there is no Portuguese information on EPH.Severe postpartum hemorrhage was reported to occur in 6.7/1,000 deliveries worldwide. It is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face [11]. The main causes of the uncontrollable hemorrhage necessitating an EPH have changed since the 1980s [2]. Uterine atony and rupture have been overtaken by abnormal placentation in many studies. This is not only because of improved conservative management of uterine atony and a reduced incidence of uterine rupture due to the extensive use of the lower uterine segment inci...

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confidence: 48%

Emergency Peripartum Hysterectomy: A 10-Year Review

Carvalho

Cubal

Torres

et al. 2012

ISRN Emergency Medicine

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“…Occasionally pulmonary embolism occurs. Many complications such as bleeding, infections and fistula may require relaporotomy or reoperation for proper management [11,21,22].Three patients have presented a sepsis, factors like delay for better care, prolonged or obstruted labor can explained our proportion.…”

Section: Discussionmentioning

confidence: 95%

“…Peripartum hysterectomy has been described as one of the catastrophes of modern obstetrics [1,21,22]. The difficulties associated with the procedure are not necessarily the surgical technique but the anatomical and physiological changes associated with late pregnancy and the indications for the surgery as well as the support for such ill patients [21,22]. These difficulties are more pronounced in developing countries where patients present very late and the facilities for intensive care are lacking [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent complication of peripartum hysterectomy is excessive blood loss and need for transfusion [21,22]. Only part of this blood loss is attributable to the procedure itself.…”

Section: Discussionmentioning

confidence: 99%

“…The post operative complications include bleeding, wound sepsis/dehiscence, urinary tract infections, ileus, anemia, prolonged duration of hospital stay and/or injury after urinary tract infection [21,22]. Occasionally pulmonary embolism occurs.…”

Section: Discussionmentioning

confidence: 99%

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Obstetric Hysterectomy Performed at N’Djamena Mother and Child Hospital (Chad): Indications and Prognosis

Lhagadang¹

2016

OGIJ

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Results FrequencyDuring the study period 29,490 patients were delivered at N'Djamena Mother and child hospital. A total of 46 obstetrics hysterectomies were performed, 11(24%) followed vaginal delivery, 29 (63%) during the course of, or following a caesarean section, and 6(13%) in the postpartum period. The frequency of obstetric hysterectomy was 0.16% of all deliveries (i.e., 1.6 obstetric hysterectomies for 1000 deliveries) ( Table 1).The age group between 30-34 years was the most represented with 41.3%. The average age was 31.2 years, with the extremes ranging from 15 to 44 years. Twenty six patients (56.5%) were not schooled. Parity ranged from 1-13, with a mean of 6.2 ± Research ArticleObstet Gynecol Int J 2016, 4(1): 00095 AbstractBackground: Obstetric hysterectomy is a life saving procedure in severe obstetrical hemorrhage.Objective: Determine its frequency, indications and prognosis. Patients and methods:This was a retrospective and descriptive survey performed at the department of Obstetrics and Gynecology, of N'Djamena Mother and Child Hospital. All patients who had undergone obstetric hysterectomy during the four-year study period from April 2011 to April 2015 were studied.Results: During the study period, 29,490 patients were delivered at N'Djamena Mother and child hospital. A total of 46 obstetrics hysterectomies were performed that give a frequency of 0.16%. The average age was 31.2 years, with the extremes ranging from 15 to 44 years. Parity ranged from 1-13 with 41.7% of grand multipara. The commonest cause of obstetric hysterectomy was ruptured uterus, seen in 29 (63%) patients. Uterine atony was responsible in 10 (21.7%) cases. In 91.3% of the cases (n=42) subtotal hysterectomy was performed and in others total hysterectomy was performed (8.7%). Main maternal complications were: sepsis (6.5%) and urological injuries (6.5%). Maternal outcome was enameled by three deaths giving a lethality rate of 6.5%. Fetal prognosis was worst with a fetal death rate of 69.5%. Conclusion:Obstetric hysterectomy remains frequent in our regions. Adequate prenatal consultation and surveillance of patients during labor are required for curbing the frequency of obstetric hysterectomy.

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Adenomyosis among patients undergoing postpartum hysterectomy for uncontrollable uterine bleeding: A multicenter, observational, retrospective, cohort study on histologically‐based prevalence and clinical characteristics

Giorgi,

Raimondo,

Pacifici

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo assess the prevalence of adenomyosis at pathologic examination, and its association with obstetric complications, peripartum maternal clinical characteristics and neonatal birth weight in patients undergoing postpartum hysterectomy due to postpartum hemorrhage (PPH).MethodsA multicenter, observational, retrospective, cohort study was carried out including all women who underwent postpartum hysterectomy due to PPH at gestational week 23+0 or later, between January 2010 and May 2023. Patients were categorized into two groups based on the presence of adenomyosis at pathologic examination, and were compared for obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weight.ResultsThe histologically‐based prevalence of adenomyosis in patients undergoing postpartum hysterectomy due to PPH was 39.4%. Adenomyosis was associated with a longer hospitalization time (regression coefficient: 4.43 days, 95% CI: 0.34–8.52, P = 0.034) and a higher risk of hypertensive disorders (OR: 5.82, 95% CI: 1.38–24.46, P = 0.016), threatened preterm labor (OR: 3.34, 95% CI: 1.08–10.31, P = 0.036), urgent/emergency C‐section (OR: 24.15, 95% CI: 2.60–223.96, P = 0.005), postpartum maternal complications (OR: 4.96, 95% CI: 1.48–16.67, P = 0.012), maternal intensive care unit admission (OR: 3.56, 95% CI: 1.05–12.05, P = 0.041), and low birth weight neonates (OR: 3.8, 95% CI: 1.32–11.02, P = 0.013).ConclusionIn patients undergoing postpartum hysterectomy due to PPH, adenomyosis is a highly prevalent condition among, and is associated with adverse obstetric, maternal, and neonatal outcomes.

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Emergency peripartum hysterectomy: a 9-year review

Cited by 90 publications

References 20 publications

Emergency Peripartum Hysterectomy: A 10-Year Review

Emergency Peripartum Hysterectomy: A 10-Year Review

Obstetric Hysterectomy Performed at N’Djamena Mother and Child Hospital (Chad): Indications and Prognosis

Adenomyosis among patients undergoing postpartum hysterectomy for uncontrollable uterine bleeding: A multicenter, observational, retrospective, cohort study on histologically‐based prevalence and clinical characteristics

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