Morbidity and Mortality of Peripartum Hysterectomy

Wright, Jason D.; Devine, Philip E.; Shah, Monjri M.; Gaddipati, Sreedhar; Lewin, Sharyn N.; Simpson, Lynn L.; Bonanno, Clarissa; Sun, Xuming; D’Alton, Mary E.; Herzog, Thomas J.

doi:10.1097/aog.0b013e3181df94fb

Cited by 128 publications

(68 citation statements)

References 22 publications

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“…Rates of reoperation (4 % compared with 0.5 %), postoperative haemorrhage (5 % compared with 2 %), wound complications (10 % compared with 3 %) and venous thromboembolism (1 % compared with 0.7 %) were all higher in women who underwent peripartum hysterectomy. In multivariable analysis, the odds ratio for death from peripartum compared to nonobstetric hysterectomy was 14.4 (95 % confidence interval 9.84-20.98) [38].…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…Furthermore, the ureters may be sectioned, clamped or stitched because of heavy bleeding that interferes with proper exposure. The reported incidence of urological injuries with peripartum hysterectomy is high [38]. Within the context of the emergency situation and the available resources, it is best to diagnose and deal with any bladder or ureteric injury at the time of the hysterectomy.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…To arrest postpartum haemorrhage, algorithms have been proposed to aid its systematic management. Procedures for immediate management of postpartum haemorrhage include the use of pharmacological uterotonic drugs (Table 2), uterine massage or bimanual uterine compression on an empty bladder, the initiation of blood and blood components therapy (Table 3), repair of genital tract lacerations, evacuation of retained products of conception, the implementation of uterine or internal iliac arteries or anterior division of internal iliac arteries embolisation (Figure 1), uterine tamponade techniques (Table 4) (Figure 2), uterine compression sutures (Figure 3), systematic pelvic devascularisation (Figure 4), internal iliac artery ligation ( Figure 5) and recombinant-activated factor VII for category III and IV postpartum haemorrhage [37][38][39][40][41][42][43][44] . Consideration should be given to the possibility that placenta praevia percreta may extend into the bladder and other pelvic organs.…”

Section: Postpartum Haemorrhagementioning

confidence: 99%

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Peripartum Hysterectomy

Amarin¹

2015

Approaches to Hysterectomy

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Section: Morbidity and Mortalitymentioning

confidence: 99%

Section: Morbidity and Mortalitymentioning

confidence: 99%

Section: Postpartum Haemorrhagementioning

confidence: 99%

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Peripartum Hysterectomy

Amarin¹

2015

Approaches to Hysterectomy

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“…14 Wright et al analyzed morbidity and mortality of peripartum hysterectomy and concluded that it is accompanied by substantial mortality (14.4%) and morbidity in terms of bladder injuries (9%), ureteral injuries (0.7%), postoperative haemorrhage (5%), wound complications (10%), venous thromboembolism (1%). 15 Chawla et al in a retrospective, observational, and analytical study over a period of eight years had 56 cases of emergency obstetric hysterectomy (EOH) and reported maternal mortality (17.7%) and perinatal mortality (37.5%). 7 Mukherjee et al in a retrospective study of obstetric hysterectomy in a tertiary care hospital reported no maternal mortality but high perinatal mortality (54.5%).…”

Section: 2mentioning

confidence: 99%

Changing trends in incidence, type, indication and maternal outcome of peripartum hysterectomy over 10 years at a tertiary care centre

Gupta

Deepika

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Peripartum hysterectomy is the most dramatic operation in modern obstetrics and is generally performed when all conservative measures fail to achieve haemostasis in the setting of life threatening haemorrhage. The objective was to review all peripartum hysterectomies performed at a tertiary care centre over a ten-year period from 2007 to 2016 to determine the incidence, types, indications and maternal outcome and also to study the changing trendsMethods: This was a retrospective, observational, analytical study of parturient women requiring peripartum hysterectomy (PH). We looked at data over a ten-year period, from January 2007 to December 2016. Case records were reviewed for socio-demographic characteristics of the patients, type and indications for the hysterectomy performed, booking status of patients, mode of delivery, gestational age at delivery and maternal outcome. Change in trends of the rate and indications of peripartum hysterectomy at the centre was also reviewed.Results: The overall rate of peripartum hysterectomy was 1/876 deliveries. The rate of peripartum hysterectomy had a 4-fold rise from 2007 to 2016.The primary indication was abnormal placentation which included morbidly adherent placentation 22/59 (37.2%) and placentapraevia 5/59 (8.4%), followed by intractable atonic haemorrhage in 35.6% of cases. Abnormal placentation as an indication for PH increased significantly form 34.6% (2007-2011) to 54.54% (2012-2016). After hysterectomy, 56% cases were admitted to ICU. All patients needed blood transfusion. Maternal mortality was 10.1%.Conclusions: Peripartum hysterectomy is a most demanding obstetric surgery performed in very trying circumstances of life threatening hemorrhage. The indication for emergency peripartum hysterectomy in recent years has changed from traditional uterine atony to abnormal placentation.

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“…[1] Despite many publications, the definition of a peripartum hysterectomy remains vague. Definitions include a hysterectomy performed within 24 hours of delivery, [2][3][4][5] a hysterectomy performed within the same hospitalisation, [6][7][8][9][10] a hysterectomy performed within 72 hours of delivery, [11] a hysterectomy performed within 1 month of delivery [12,13] to a hysterectomy performed within 6 weeks of delivery.…”

mentioning

confidence: 99%

Sepsis: Primary indication for peripartum hysterectomies in a South African setting

Vuuren

Cluver

2016

S Afr J OG

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Background. Peripartum hysterectomies are lifesaving procedures but definitions vary. Indications are variable and dependant on resources and geographical factors. Objectives. To evaluate the incidence, aetiology and complications associated with peripartum hysterectomies in a tertiary hospital in South Africa. Methods. A retrospective audit at an academic referral centre over a 5-year period from February 2009 to March 2014 was performed.Procedures from a gestation of 24 weeks until 6 weeks postpartum were included. Results. One hundred and sixty cases met inclusion criteria. Nine case records were unavailable. The incidence was 2.77 per 1 000 deliveries. Main indications were sepsis (60, 39.7%), atony (24, 15.9%), morbidly adherent placenta (21, 13.9%), tears (14, 9.3%), uterine rupture (8, 5.3%), placenta praevia (7, 4.6%) and unclassified bleeding (6, 4.0%). There were 6 maternal deaths. Five related to sepsis and one to hypovolaemic shock. One hundred and thirty-eight (91.4%) women required high or intensive care admission. Conclusion. Sepsis is an important aetiology for peripartum hysterectomies, particularly in southern Africa. The high rate of sepsis may be due to HIV infection, low socioeconomic standards, late diagnosis, limited access to healthcare, sterility issues and differences in the definition and inclusion criteria used for a peripartum hysterectomy. A peripartum hysterectomy is a lifesaving procedure usually performed as an emergency that can be associated with significant morbidity and mortality.[1] Despite many publications, the definition of a peripartum hysterectomy remains vague. Definitions include a hysterectomy performed within 24 hours of delivery, [2][3][4][5] a hysterectomy performed within the same hospitalisation, [6][7][8][9][10] a hysterectomy performed within 72 hours of delivery, [11] a hysterectomy performed within 1 month of delivery [12,13] to a hysterectomy performed within 6 weeks of delivery. [14] Some even limit the definition to a hysterectomy performed for uncontrolled haemorrhage only [4,[15][16][17][18][19][20][21][22] and exclude cases of infection.[12] The varying definitions make it difficult to compare incidences and aetiology. If a short time period after delivery is used, complications related to sepsis and delayed haemorrhage may be underestimated.Peripartum hysterectomies complicate about 1 in 1 000 pregnancies.[23] The incidence is lower in higher-resource settings. In a large review from the USA the incidence was 0.77 per 1 000 deliveries [10] while African countries have reported higher incidences ranging from 4.34 to 9.5 per 1 000 deliveries. [9,14,17,19] Lack of antenatal and peripartum care due to limited resources, a high burden of HIV infection and a delay in recognising complications may be reasons for the higher incidences.In high-resource settings complications of placentation are the most common indication for hysterectomy. [5][6][7][8]11,12,22,24,25] In middle-income countries the aetiology is variable, with studies from Turkey, India and Thail...

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Morbidity and Mortality of Peripartum Hysterectomy

Abstract: II.

Cited by 128 publications

References 22 publications

Peripartum Hysterectomy

Peripartum Hysterectomy

Changing trends in incidence, type, indication and maternal outcome of peripartum hysterectomy over 10 years at a tertiary care centre

Sepsis: Primary indication for peripartum hysterectomies in a South African setting

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