Emergency Peripartum Hysterectomy:  Indications and Outcome in a Tertiary  Care Setting

Singla, Anshuja; Mundhra, Rajlaxmi; Phogat, Latika; Mehta, Sumita; Rajaram, Shalini

doi:10.7860/jcdr/2017/19665.9347

Cited by 5 publications

(12 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies have shown that caesarean section per se increases the risk of EPH. 12,13,11,9 In agreement with these, our study showed that the rate of EPH was 5 per 1000 caesarean deliveries as against 0.6 per vaginal deliveries. Thus, as shown in Table 4, the relative risk of EPH was 8.44 for caesarean deliveries compared to vaginal deliveries.…”

Section: Discussionsupporting

confidence: 87%

“…The incidence of EPH of 2.1 per 1000 deliveries in our series is comparable with other reported studies. 5,6,7,8,9 Common indications for EPH were abnormal placentation with previous caesarean section (52.14%) followed by uterine atony (19.04%). Wani RV et al 10 in their series showed that 77.4% of cases of EPH were done for abnormal placentation and 14.5% for uterine atony.…”

Section: Discussionmentioning

confidence: 99%

“…In this series, there were 2 maternal deaths (1.9%), which was less compared other studies. 9,20 Delay in deciding to perform hysterectomy and related hypotension and irreversible shock may have been the prime factors in both cases. Begum M et al 18 in their study also found that early decision for hysterectomy may likely decreased maternal morbidities and deaths.…”

Section: Risk Factors-csmentioning

confidence: 99%

See 2 more Smart Citations

Emergency Peripartum Hysterectomy- Still a Life-Saving Tool in Modern Day Obstetrics- A 3-Year Study

Chandramathy¹,

H²,

Reshma³

et al. 2017

jebmh

View full text Add to dashboard Cite

BACKGROUND Emergency Peripartum Hysterectomy (EPH) implies removal of uterus at the time of delivery or in the immediate postpartum period, usually carried out as a last resort in uncontrollable life-threatening obstetric haemorrhage. Recent studies show an increase in these procedures being done for abnormal placentation, which refers to both placenta praevia and morbidly adherent placenta praevia or accreta. The aim of the study is to determine the incidence, indications, risk factors and complications of Emergency Peripartum Hysterectomy (EPH). MATERIALS AND METHODS This is a retrospective case series involving detailed examination of the case records of patients for 3 years who had emergency peripartum hysterectomy between January 2013 and December 2015 in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode. We analysed the incidence, indications, risk factors, type of hysterectomy and the complications of emergency peripartum hysterectomy. RESULTS There were 49,125 deliveries of which 65.22% were vaginal and 34.78% were by caesarean section. Hundred and five women underwent emergency peripartum hysterectomy giving an incidence of 2.1 per 1000 deliveries. The indications of EPH were mainly placenta previa with prior caesarean section. Morbidly adherent placenta was seen in 60 of the 63 (60%) cases followed by atonic PPH (19%) and rupture uterus (10.47%). There were two cases of maternal death. Inadvertent cystotomy was the most important complication in our series (6.66%). Sixty nine (65.7%) had previous delivery by caesarean section and 74 (70.4%) women delivered by caesarean section. CONCLUSION Morbidly adherent placenta in women with prior CS was the most common indication to perform emergency peripartum hysterectomy. Timely decision for hysterectomy significantly reduced the maternal morbidity and is a lifesaving procedure.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Risk Factors-csmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Peripartum Hysterectomy- Still a Life-Saving Tool in Modern Day Obstetrics- A 3-Year Study

Chandramathy¹,

H²,

Reshma³

et al. 2017

jebmh

View full text Add to dashboard Cite

show abstract

“…Uterine rupture is associated with multi-parity, augmented labor and previous CS with scar dehiscence and leads to high maternal and fetal mortality [8]. Most studies from India have reported post-partum uterine inertia or atonic hemorrhage as the most common cause of EOH; in contrast, uterine inertia was histologically diagnosed in only two of our cases [1,18]. Uterine inertia results from failure of the uterine muscles to contract during the third stage of delivery and leads to torrential blood loss, and has been associated with sepsis, anemia, previous CS, obstructed labor and multiparty [10].…”

Section: Discussionmentioning

confidence: 71%

“…Korejo et al have reported ovarian conservation in all cases, whereas, Siddiq et al have not reported oophorectomy with their cases of EOH [7,13]. In most of the Indian studies, adnexa have not been reported [1,10,18,19]. A study from Poland has reported oophorectomy in 15% of cases due to neoplastic condition in the ovaries or hematoma of the peritoneum [20].…”

Section: Discussionmentioning

confidence: 99%

Emergency Obstetric Hysterectomy, the Histopathological Perspective: A Cross-Sectional Study From a Tertiary Care Hospital

Shahid¹,

Abbas²,

Mumtaz³

et al. 2020

Cureus

View full text Add to dashboard Cite

Introduction Emergency obstetric hysterectomy (EOH) is a life-saving procedure which involves the surgical removal of uterus and is usually performed for uncontrollable maternal hemorrhage when all other conservative management has failed. This study was conducted to evaluate the histopathological findings in the EOH specimen received in the department of pathology. Methods This hospital-based cross-sectional study was conducted in the Histopathology Laboratory, Department of Pathology, and Dow Medical College (DMC) from September 2017 to December 2018. The histopathological findings in the EOH specimen were recorded and data was analyzed. Results Ninety-six cases of EOH were received. The incidence of emergency obstetric hysterectomy was 58.37/10,000 deliveries. The mean age of patients was 30.59 years (range 20-45 years). The main histopathological findings were placenta accreta spectrum in 61 (63.54%) cases, cervical tear in eight (8.33%), uterine rupture in seven (7.29%) and endomyometritis in six (6.25%) cases. In the placenta accreta spectrum, placenta accreta was the most frequent diagnosis in 23 (23.96%) of cases, placenta increta in 17 (17.71%), placenta percreta in 10 (10.42%) cases. Seven (7.29%) cases of placenta percreta and four (4.17%) cases of placenta accreta were diagnosed in association with placenta previa. Twenty placentas were received with the hysterectomies, of these eight (40%) placentas showed infarction and six (30%) had intervillous fibrin, both findings were suggestive of uteroplacental insufficiency, while three (15%) placentas had normal histology. Ovaries were received with the hysterectomies in 11 (11.46%) cases. Mature cystic teratoma was diagnosed in two (2.08%) ovaries while the majority of ovaries were normal on histology. Conclusion Placenta accreta spectrum is the leading histopathological finding in the EOH specimen. Regular antenatal follow-1 2 1 1 3 4 4 4

show abstract

Systematic review of urological injury during caesarean section and hysterectomy

et al. 2022

View full text Add to dashboard Cite

Introduction and hypothesis We aim to review iatrogenic bladder and ureteric injuries sustained during caesarean section and hysterectomy. Methods A search of Cochrane, Embase, Medline and grey literature was performed using methods pre-published on PROSPERO. Eligible studies described iatrogenic bladder or ureter injury rates during caesarean section or hysterectomy. The 15 largest studies were included for each procedure sub-type and meta-analyses performed. The primary outcome was injury incidence. Secondary outcomes were risk factors and preventative measures. Results Ninety-six eligible studies were identified, representing 1,741,894 women. Amongst women undergoing caesarean section, weighted pooled rates of bladder or ureteric injury per 100,000 procedures were 267 or 9 events respectively. Injury rates during hysterectomy varied by approach and pathological condition. Weighted pooled mean rates for bladder injury were 212–997 events per 100,000 procedures for all approaches (open, vaginal, laparoscopic, laparoscopically assisted vaginal and robot assisted) and all pathological conditions (benign, malignant, any), except for open peripartum hysterectomy (6,279 events) and laparoscopic hysterectomy for malignancy (1,553 events). Similarly, weighted pooled mean rates for ureteric injury were 9–577 events per 100,000 procedures for all hysterectomy approaches and pathologies, except for open peripartum hysterectomy (666 events) and laparoscopic hysterectomy for malignancy (814 events). Surgeon inexperience was the prime risk factor for injury, and improved anatomical knowledge the leading preventative strategy. Conclusions Caesarean section and most types of hysterectomy carry low rates of urological injury. Obstetricians and gynaecologists should counsel the patient for her individual risk of injury, prospectively establish risk factors and implement preventative strategies.

show abstract

Emergency Peripartum Hysterectomy: Indications and Outcome in a Tertiary Care Setting

Cited by 5 publications

References 8 publications

Emergency Peripartum Hysterectomy- Still a Life-Saving Tool in Modern Day Obstetrics- A 3-Year Study

Emergency Peripartum Hysterectomy- Still a Life-Saving Tool in Modern Day Obstetrics- A 3-Year Study

Emergency Obstetric Hysterectomy, the Histopathological Perspective: A Cross-Sectional Study From a Tertiary Care Hospital

Systematic review of urological injury during caesarean section and hysterectomy

Contact Info

Product

Resources

About