Frequency and causes of emergency hysterectomy along with vaginal delivery and caesarean section in Hamadan, Iran

Abstract

BackgroundEmergency hysterectomy (peripartum) is a high-risk surgery that almost always is done in the treatment or prevention of severe and life-threatening bleeding that occurs after vaginal delivery or caesarean.ObjectiveTo compare the frequency and causes of emergency hysterectomy along with the vaginal delivery and caesarean section (CS).MethodsThe cross-sectional research was conducted on patients who underwent a peripartum hysterectomy from 2005 to 2015 at Fatemieh Hospital in Hamadan City, Iran. Data collection tools included a questionnaire about demographic features and factors associated with hysterectomy surgery. Data were analyzed using SPSS version 21 and by descriptive statistics, chi-square, paired t-test, and one-way analysis of variance (ANOVA).ResultsThe mean age of women was 33.4±5.09 years. In recent years, 37 cases of hysterectomy were reported, with the peak occurring in 2015. The highest prevalence of hysterectomy was associated with 28 (77.8%) women with a third pregnancy and second parity, while 32 cases (86.5) were related to those with no history of vaginal delivery, 15 (45.5%) were related to repeated CS and second repeated CS; 28 cases (75.7%) to those with no history of placenta previa; 21 cases (56.8) to the majority with the anterior placenta;, 33 cases (97.1%) to those with no over-distance of uterine; and 36 cases (97.3%) to those without a history of uterine myoma. Among 37 cases who had hysterectomy, placenta accreta was observed in 27 cases (77.1%), with placenta increta in three (8.1%) and placental attachment, including percreta, were seen in seven cases (18.9 %).ConclusionThe rate of hysterectomy in multiparous women (in their third or fourth pregnancy) was higher. The greatest cause of hysterectomy was related to attached placenta including accreta, uterus atony, a history of CS, multipara, and repeated CS. Therefore, due to the increase in the number of CSs in recent years, planning should be taken into account in order to encourage pregnant women for vaginal delivery.

Postpartum Hysterectomy Indications of a Tertiary Referral Center

“…Similarly, a study from Iran has demonstrated that postpartum hysterectomy increses with previous caesarean section history. 14 Placenta invasion anomalies were higher with a history of caesarean section (94/98=96%) than without previous uterine surgery (4/98=4%) (p<0.001). The incidence has also variations in different regions of Turkey (ranging between 0.25 and 5.3/1000 live birth).…”

The relation between obstetric conjugate diameter during pregnancy and the type of delivery: a narrative review

“…3 The obstetric intervention is necessary to reduce the side effect comes from cesarean section such as the increased risk of placenta previa, hysterectomy, and surgeons wound infections. [4][5][6] The obstetric conjugate diameter is defined as the distance between the sacral promontory and the inner midpoint of the symphysis pubis (Figures 1, 2); otherwise, it's the first area in which the head of the fetus had passed during the first stage of delivery. [7][8][9][10][11][12] During pregnancy, the obstetric conjugate diameter is mainly measured by radiography such as X-rays, ultrasound, computed tomography (CT), stereo radiographic imaging, and magnetic resonance.…”

Evaluation and comparison of sensitivity and specificity of ultrasonography in placenta accreta diagnosis in the second and third trimesters

“…As per statistics published in 2017, the prevalence of CS in some parts of Iran was more than 70% of births per year. [ 14 ] Following an increase in the rate of CS, its complications, including PAS, will increase significantly. It is very important to have an affordable, accurate, and reliable diagnostic method for timely diagnosis of PAS during the second and third trimesters in high-risk mothers.…”