Obstetric hysterectomy: A review of cases over 16 years

Abstract

Emergency peripartum hysterectomy (EPH), is performed when life-threatening obstetric conditions occur. The authors attempt to assess the incidence of EPH as well as to investigate risk factors and patients' characteristics. A retrospective study of all cases of EPH performed at the 2nd Department of Obstetrics and Gynecology, Medical School of Athens University, from 1994 to 2009 has been conducted. Data were abstracted from individual medical charts and laboratory records. Among 16,182 deliveries, 15 EPH were performed (0.92 per 1,000 deliveries). Indication was uncontrollable haemorrhage due to placenta accreta (73.3%) or uterine atony (26.6%). Incidence of 1.54 EPHs per 1,000 caesarean sections and 0.51 per 1,000 vaginal deliveries, were noted. Morbidity rate was 46.6%. One (6.6%) mother died because of pulmonary embolism. In conclusion, peripartum hysterectomy is a severe but life-saving procedure. Caesarean section increases the risk of EPH. Obstetricians should always be prepared to confront this emergency situation.

Peripartum hysterectomy - an eleven-year experience at an academic center in jeddah

“…Historically, the most prevalent indication for emergency PH was uterine atony. However, a number of studies have suggested that abnormal placentation (including placenta previa, increta, accrete, and percreta) is a major risk factor of CSs, which are increasing in number (2,6,8,10,13) and resulting in the higher incidence of emergency PH (1)(2)(3)(4)(5)(6)16). In modern obstetrics, the overall incidence of emergency PH is 0.05%; however, perceptible differences exist in different parts of the world.…”

“…Peripartum hysterectomy (PH) is a major surgical procedure, typically performed as an emergency measure during or within 24 hours of abdominal or vaginal deliveries due to lifethreatening hemorrhage (1). It has an incidence of0.…”

“…24-8.7 per 1000 deliveries and is more common following cesarean section (CS) compared with vaginal deliveries (1,2). Peripartum hysterectomy continues to be one of the top three leading causes of maternal mortality worldwide (3).Although proposed in 1869, the first cesarean subtotal hysterectomy was successfully performed in 1876, resulting in the survival of both the mother and her newborn (4,5).Peripartum hysterectomy is associated with significant maternal morbidity (26.5-31.5%) and mortality (0-12.5%) (1,2). The main indication for emergency PH is abnormal placentation (placenta previa, placenta accreta, placental bed pathology), but the underlying causes for abnormal placentation can vary.…”

Obstetric Hysterectomy As A Surgical Intervention in the Management of Obstetric Haemorrhage At the University of Port Harcourt Teaching Hospital, Nigeria.

“…[7][8][9] It is however lower than those reported from developed countries. [15] This may be because of the higher parity, cultural and religious beliefs, aversion to repeat caesarean section, large numbers of unbooked emergencies and antenatal defaulters in our environment. Also, our institution is an important referral center in this region and most of our cases were referred from outside in moribund condition after complications occurred.…”

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

“…Such haemorrhage is most commonly due to abnormal placentation45 to 73.3% and uterine atony, accounting for 26.6% to 35.6% percent of peripartum hysterectomies. [1][2][3] Other potential causes of severe intrapartum or postpartum uterine haemorrhage include uterine rupture, leiomyomas, and laceration of uterine vessels. Planned peripartum hysterectomy may be performed in patients with an antepartum diagnosis of placenta accreta or stage IA2 and IB1 cervical carcinoma.…”