Emergency peripartum hysterectomy in a tertiary London hospital

Selo-Ojeme, Dan; Bhattacharjee, Parijat; Izuwa-Njoku, Ngozi F.; Kadir, Rezan A.

doi:10.1007/s00404-004-0715-x

Cited by 128 publications

(84 citation statements)

References 10 publications

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“…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]. The febrile morbidity rate of 7.7% is lower than that of their studies [14,17,28]. There was one maternal death (7.7%) in our study.…”

Section: Discussioncontrasting

confidence: 63%

“…Other factors that have been associated with EPH include advanced maternal age, multiparity, multiple gestations, and gestational diabetes. [2,[12][13][14][15][16] Conservative treatment of postpartum hemorrhage includes uterotonics (oxytocin, ergotamine), uterine massage, uterine artery embolization, uterine packing, pelvic vessel ligation, B-Lynch suture, multiple square sutures, and recombinant-activated factor VII [17]. The most severe complication of hemorrhage is maternal death, whose risk is estimated to be approximately 1 in 100,000 deliveries in developed countries and has been increasing.…”

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confidence: 99%

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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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Section: Discussioncontrasting

confidence: 63%

mentioning

confidence: 99%

Emergency Peripartum Hysterectomy: A 10-Year Review

Carvalho

Cubal

Torres

et al. 2012

ISRN Emergency Medicine

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“…In UK, at tertiary care centre, there were 15 cases of emergency peripartum hysterectomy in 31,079 deliveries, giving the incidence of 0.48 per 1,000. Haemorrhage due to placenta praevia especially in repeat C section was the main indication for emergency peripartum hysterectomy (47 %) [7] while in Turkey at tertiary care centre, the incidence of emergency peripartum hysterectomy was 0.67 in 1,000 deliveries and hemorrhage due to uterine atony was the main indication for emergency hysterectomy (57.1 %). [8].…”

Section: Introductionmentioning

confidence: 99%

Maternal Near Miss Review: A Way Forward

Purandare

2013

J Obstet Gynecol India

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“…The incidence of emergency peripartum hysterectomy in this study did change significantly over the five year period giving an overall incidence of 3 per 1000 deliveries. This incidence is lower than the one reported from a study by Kwame-Aryee et al (2007) at Korle-Bu teaching hospital in Ghana, but higher than that reported in most studies elsewhere (Zamzami 2003;Okogbenin et al, 2003;El-Jallad et al, 2004;Selo-Ojeme et al, 2005;Katchy et al, 2006;Kwee et al, 2006;Yucel et al, 2006). The higher incidence of peripartum hysterectomy at Muhimbili may be due to the characteristic of the hospital being a referral institution, thus receiving cases which may need the procedure.…”

Section: Discussionmentioning

confidence: 52%

Emergency peripartum hysterectomies at Muhimbili National Hospital, Tanzania: Review of cases from 2003 to 2007

Pembe

Wangwe

Massawe

2012

Tanzania J Hlth Res

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Abstract:A retrospective review of all cases of emergency peripartum hysterectomy performed between January 1, 2003 and December 31, 2007 at Muhimbili National Hospital was done to determine the incidence, indications and complications, background characteristics, antenatal care attendance, referral status, and maternal and foetal outcomes. There were 55,152 deliveries during the study period and 165 cases of emergency peripartum hysterectomy, giving the incidence of emergency peripartum hysterectomy of 3 per 1000 deliveries. The main indication was uterine rupture (79%) followed by severe post-partum haemorrhage due to uterine atony (12.7%). The case fatality rate was 10.3% where as perinatal mortality rate was 7.7 per 1000 deliveries. The common complication identified intraoperatively was severe haemorrhage which accounted for 39.4% where as intensive care unit admissions (14.4%) and febrile morbidity (12.4%) were common after the operation. Blood was ordered in all cases but in 31 cases it was indicated that it was not available. Seventy nine patients received blood transfusion with the maximum number of units given to one patient being eight. Twenty two patients were given fresh frozen plasma (FFP), the median number of units given was two (range = 1-6). In conclusion, emergency peripartum hysterectomy is a life saving procedure and very common at MNH. The most common indication was ruptured uterus followed by severe postpartum haemorrhage. More than half of the patients underwent emergency peripartum hysterectomy were referred from other health facilities with ruptured or suspected ruptured uterus. The procedure was associated with unacceptably high maternal and perinatal morbidity and mortality. ______________________________________________________________________________

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Emergency peripartum hysterectomy in a tertiary London hospital

Abstract: Caesarean deliveries, especially repeat caesareans in women with placenta praevia, significantly increase the risk of emergency peripartum hysterectomy.

Cited by 128 publications

References 10 publications

Emergency Peripartum Hysterectomy: A 10-Year Review

Emergency Peripartum Hysterectomy: A 10-Year Review

Maternal Near Miss Review: A Way Forward

Emergency peripartum hysterectomies at Muhimbili National Hospital, Tanzania: Review of cases from 2003 to 2007

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