ABSTRACT
Abstract Objective To compare the outcomes of emergency and planned peripartum hysterectomies. Methods The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies. Results A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p=0.014), and higher postoperative hemoglobin levels (9.9±1.3 versus 8.3±1.3; p<0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases. Conclusion Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.
Resumo Objetivo Comparar os resultados das histerectomias periparto de emergência e planejada. Métodos Este estudo transversal retrospectivo foi realizado em dois hospitais. Os resultados maternos e neonatais foram comparados de acordo com as histerectomias periparto de emergência e planejada. Resultados Um total de 34.020 partos foram avaliados retrospectivamente, e 66 casos de histerectomia periparto foram analisados. Destes, 31 eram casos de cirurgias planejadas, e 35, cirurgias de emergência. As pacientes que foram submetidas à histerectomia periparto planejada tiveram uma taxa menor de transfusão de sangue (83,9% versus 100%; p=0,014), e níveis mais elevados de hemoglobina pós-operatória (9,9±1,3 versus 8,3±1,3; p<0,001) em comparação com o grupo de histerectomia de emergência. O peso ao nascer foi menor, embora as pontuações na escala de aparência, frequência cardíaca, irritabilidade reflexa, tônus muscular, e respiração (appearance, pulse, grimace, activity, and respiration, Apgar, em inglês) fossem maiores no grupo da cirurgia planejada em comparação com os casos de emergência. Conclusão A histerectomia periparto planejada com uma equipe experiente resulta em menos necessidade de transfusão e melhora os resultados neonatais em relação à histerectomia periparto de emergência.
Subject(s)
Humans , Female , Pregnancy , Placentation , Emergencies , HysterectomyABSTRACT
Background: Emergency peripartum hysterectomy (EPH) is a major surgical venture invariably performed in the setting of life-threatening haemorrhage during or immediately after abdominal and vaginal deliveries. Aim of the study was to study the frequency and indications for peripartum hysterectomy and to assess the maternal outcome of peripartum hysterectomy.Methods: Cross sectional study was done in the department of obstetrics and gynaecology, Vanivilas hospital, Bangalore from September 2018 to august 2019. This study consists of 24 cases of emergency peripartum hysterectomy within 24 hours of delivery, operated at Vanivilas hospital.Results: The frequency of peripartum hysterectomy was 1.102/1000 deliveries and following caesarean section and vaginal deliveries are 3.544/1000 deliveries and 0.248/1000 deliveries respectively. Among 24 cases who had peripartum hysterectomy, 16 cases were delivered by caesarean section and 4 cases delivered by vaginal route while another 4 cases delivered by laparotomy for rupture uterus. 22 cases (91.67%) survived with major number of cases having morbidities and there were 2 (8.33%) maternal death.Conclusions: The most common mode of delivery before peripartum hysterectomy was Caesarean section. The most common indication was atonic postpartum haemorrhage. Better protocols for induction and augmentation of labour will decrease the necessity of peripartum hysterectomies.
ABSTRACT
A broad ligament pregnancy is a rare condition, but full term broad ligamnet pregnancy especially in an unscarred uterus is extremely rare. It is often misdiagnosed and usually finally diagnosed during surgery. Here is case of full term broad ligament pregnancy, which remained undiagnosed throughout her pregnancy, unfortunately had IUFD. Patient was referred to our hospital in view of failure of induction with increased BP records. No ultrasound was available on admission. On clinical assessment it appeared as transverse lie with IUFD. So cesarean was decided as a mode of delivery. Emergency ultrasound could just confirm IUFD with pelvic mass? Fibroid (actually deviated uterus). On laparotomy the broad ligament pseudosac had occupied entire abdomen. After delivery of baby, anatomy was found completely distorted. Highly vascular omental adhesions on fundus with difficulty in placental removal. Placenta could be traced reaching abdomen posteriorly. The first clinical impression was suspicion of placenta percreta. Uterus appeared non salvageable and hysterectomy was decided. Placenta was found lying in abdomen, adhered to bowel, omentum and fundus of uterus. The final diagnosis of broad ligament pregnancy could be made after the cut section of the uterus and anatomic evaluation. Patient required blood transfusions preoperatively .She remained stable and discharged on postoperative day nine. This case holds importance because may be outcome was different if it was a booked and investigated pregnancy. May be baby and uterus were salvageable with better outcome.
ABSTRACT
Emergency peripartum hysterectomy (EPH) is usually done to control bleeding of life threatening peripartum haemorrhage when all of all conservative measures fail. It is a technically demanding surgical procedure that carries high rate morbidity and mortality. From January 2016 to January 2019 data of all EPH done by our in different hospital of the city is collected. Total of 9 patients fulfil the definition of EPH. We tried with all sorts as bimanual uterine compression, administration of oxytocin or prostaglandins, uterine packing, compression sutures such as the B-Lynch brace suture before operation to controlled haemorrhage. On failure of the above mentioned measure we plan EPH. We took help of a surgeon in all of 9 cases. Bleeding is the greatest challenge in our series. Out of 9 patient 8 patient survived, one patient died of bleeding due to DIC. There is one urinary bladder injury and repaired intraoperatively. All patient has minor wound infection and that was managed with oral antibiotics and wound dressings. Postoperative average ICU stay was 3 days. Average PRBC transfusion is 4 units and two patient required FFP transfusion. In one patient we did subtotal hysterectomy and in rest all other patient we did total hysterectomy. With good team work EPH can be done with acceptable morbidity and mortality.
ABSTRACT
Background: Peripartum hysterectomy is a life-saving obstetric procedure that is performed at the time of a caesarean section or postpartum following either vaginal delivery or caesarean section. The purpose of the present study was to determine the incidence, risk factors ,indications ,maternal and neonatal morbidity, mortality and complications of emergency peripartum hysterectomy performed at a tertiary teaching hospital in South India and to compare the results with other reports in literature.Methods: During the period of study between January 2015-December 2016, there were 50 cases of emergency peripartum hysterectomy at Tirunelveli medical college hospital, Tirunelveli, Tamil Nadu, South India. Medical, pathology and operation theatre records were analyzed retrospectively. Details of maternal age, parity, booking status, underlying risk factors, past obstetric history, gestational age at delivery ,mode of delivery ,indications for emergency peripartum hysterectomy, type of operation, intraoperative and post-operative complications, blood components transfusion ,maternal and neonatal outcomes were noted and analyzed.Results: During the 2-year study period there were 50 emergency peripartum hysterectomy out of 14,363 deliveries, a rate of 1 per 294 deliveries (3.4/1000 deliveries). 80% of hysterectomies were performed after caesarean delivery and 20% after vaginal delivery. The two major indications were abnormal placentation (40%) and uterine atony (28%). There were 6 maternal deaths among patients who underwent emergency peripartum hysterectomy during the period of study.Conclusions: Improved antenatal care, correction of anaemia, identification of risk factors for peripartum hysterectomy, timely referral, expedite management, timely decision, availability and liberal use of blood components and appropriate management of post-operative complications by experienced clinical team are the main stay for saving maternal lives. With increasing rate of caesarean section there is rise in the incidence of abnormal placentation.
ABSTRACT
Background: Postpartum hemorrhage is the leading cause of maternal death in developing countries. Uterine atony is the cause in 80% of cases. Through this study, we want to determine risk factors for uterine atony after vaginal delivery route with oxytocin-mediated delivery.Methods: This is a retrospective case-control study ranging from January 1st 2017 to June 31st 2018 at the Befelatanana University Hospital Centre of Gynecology-Obstetrics. The cases consisted of patients who had spontaneous vaginal delivery in the centre and had uterine atony. Authors studied maternal, obstetrical, neonatal parameters. Authors used the R software for the statistical analysis of the results.Results: We found 40 cases of uterine atony out of 5421 deliveries with a prevalence of 0,73%. The average age was 27.73 years old±6.46 years old (p=0.113). The average parity was 2.67±1.62 (p=0.22). The total duration of labor was 6.88±2.95 hours (p=0.0187). The average duration of rupture of the membrane was 5.80±11.90 hours (0.003376). We found as risk factor of uterine atony the increase in oxytocin infusion rate during labor (OR=18.67, 95% CI 2.21-157.57), the artificial rupture of membranes (OR=5, 27, 95% CI 2.11-13.19), artificial induction of labor (OR=7.08, 95% CI 2.06-24.28) and labor over six hours (OR=2.53, 95% CI) % 1.18-5.47). In univariate analysis, premature delivery and a hypotrophic fetus were a factor risk of uterine atony (OR=3.07, 95% CI 1.27-7.44 and OR=3.43 95% CI 1.48-8.09 respectively) but this risk is not statistically significant in multivariate analysis with logistic regression (OR=1.27, 95% CI 0.40-3.84 and OR=2.19 95% CI 0.77-6.22). The main treatment was uterotonic drug use (72.5%). Authors identified seven cases of haemostasis hysterectomy and two cases of maternal death.Conclusions: Present study confirms risk factors for uterine atony already known as prolonged labor and increased oxytocic infusion rate. Unrecognized factors have been identified as a risk factor for uterine atony such as the duration of rupture of the membranes and artificial rupture of the membranes. A minimal inflammation hypothesis that reduces susceptibility to oxytocin may explain this association. Knowing these factors would reduce the occurrence of uterine atony to reduce maternal mortality.
ABSTRACT
OBJECTIVE: To analyze the risk factors for peripartum hysterectomy.METHODS: Retrospectively analyze the clinical data of 36 cases of peripartum hysterectomy in Shijiazhuang Obstetrics and Gynecology Hospital from January2012 to December 2018. The impact factors for peripartum hysterectomy were divided into clinical characteristics and obstetric treatment capacity. The annual rates of peripartum hysterectomy were compared and the risk factors for peripartum hysterectomy were analyzed by multi-factor Logistic regression analysisRESULTS: The indications of 36 cases of peripartum hysterectomy were intractable postpartum hemorrhage. The causes of hysterectomy included placenta implantation,amniotic fluid embolism,uterine atony and secondary infection. The annual rate of peripartum hysterectomy decreased gradually due to the promotion of obstetric treatment capacity. The peripartum hysterectomy rate in 2018 decreased significantly（P<0.001,P<0.001,P=0.004,P=0.009）compared with that of 2012,2013,2014 and 2015. Multifactor Logistic regression analysis showed that cesearen-section scar was a risk factor for peripartum hysterectomy（OR=1.403,P=0.018）.CONCLUSION: The severity of disease results in peripartum hysterectomy. The reduction of the peripartum hysterectomy rate lies in the promotion of obstetric treatment capacity,including improving maternal health care,reducing obstetric complications and improving the timely and effective treatment of patients with postpartum hemorrhage.
ABSTRACT
RESUMEN El espectro de acretismo placentario es un fenómeno infrecuente del embarazo cuya incidencia ha aumentado considerablemente y que está caracterizado por el anclaje anormal de las vellosidades coriónicas al miometrio, lo cual aumenta la morbi-mortalidad materna durante la resolución quirúrgica. Según las capas uterinas comprometidas, serán clasificadas como placenta acreta (contacta miometrio), increta (penetra miometrio) y percreta (compromete todo el miometrio y/o eventualmente órganos adyacentes), siendo su mayor factor de riesgo: la cesárea anterior y la placenta previa. En este artículo se realizó una revisión bibliográfica abarcando definiciones, diagnóstico y las nuevas tendencias en manejo quirúrgico no conservador propuesto en la nueva guía de la Federación Internacional de Ginecología y Obstetricia publicada en 2018 y elaborando una discusión respecto a ellas.
SUMMARY Placenta accreta spectrum is an uncommon phenomenon of pregnancy whose incidence has increased considerably over time and is characterized by the abnormal anchoring of the chorionic villi to the myometrium, which increases maternal morbidity and mortality during surgical resolution. According to the compromised uterine layers, they will be classified as placenta accreta (contacts myometrium), increta (penetrates myometrium) and percreta (compromises the entire myometrium and / or possibly adjacent organs), being previous caesarean section and placenta previous its major risk factor. In this review, we included definitions, diagnosis, and the new topics in non-conservative surgical management developed by the International Federation of Obstetrics and Gynecolgy published in 2018, and developing a discussion of the topic.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Placenta Accreta/surgery , Placenta Accreta/diagnosis , Placenta Accreta/physiopathology , Cesarean Section/methods , HysterectomyABSTRACT
Peripartum or obstetric hysterectomy is the removal of the corpus uteri alone or with the cervix at the time of a cesarean section, or shortly after a vaginal delivery. It is a challenging though life-saving obstetric procedure it is associated with morbidity and mortality. The medical records of 20 patients who had undergone peripartum hysterectomy, between April 2015 to April 2016 (1 year), in a tertiary teaching hospital, King George Hospital, Visakhapatnam, covering north coastal Andhra Pradesh and surrounding districts of Odisha were reviewed retrospectively. The results were analyzed. Emergency 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. Antenatal anticipation of the risk factors, involvement of an experienced obstetrician at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in reducing morbidity and mortality. Prompt performance of peripartum hysterectomy before patient clinical conditions deteriorate is the main key to success and less postoperative complications.
ABSTRACT
Aims: Salpingo-cutaneous fistula is an extremely rare clinical condition that can be seen after pelvic or uterine surgery. Presentation of Case: A case of an salpingo-cutaneous fistula that developed in a nulliparous woman after peripartum hysterectomy is described. The fistula tract was depicted on computed tomography, and to verify the diagnosis nuclear magnetic resonance was made. At laparotomy fistula tract was completely excised along with the enclosing ovary. Postoperative recovery and follow-up were uneventful. Discussion: Possible mechanisms of development of such a rare condition, and magnetic resonance imagining are discussed. Conclusion: The MRI has the advantage over CT in the diagnosis of unusual pelvic illness.
ABSTRACT
Background: Emergency Peripartum Hysterectomy (EPH) is a lifesaving surgical procedure. The higher incidence of EPH in developing countries is because of the higher prevalence of risk factors of primary postpartum haemorrhage like, multiple pregnancy, grandmultiparity, cephalo-pelvic disproportion and prolonged obstructed labor/uterine rupture, previous caesarean section. The increasing incidence of the procedure in developed countries has been attributed to the increasing caesarean section rate which predisposes to placenta previa. Aims & Objective: To estimate the incidence, indications and complications associated with peripartum hysterectomy performed at a tertiary care hospital. Material and Methods: The retrospective observational analytical study was conducted at the Department of Obstetrics and Gynecology, Lady Goshen hospital, Mangalore from January 2012 to December 2012. Records of all patients who had undergone peripartum hysterectomy during the study period were explored for age, parity, booking status, indication and the type of operation performed. Maternal morbidity and mortality were also recorded. Results: During the study period there were 5497 deliveries, out of which 6 women had undergone an EPH. The incidence was 1.2/1000 deliveries. The main indication was uterine atony 4 (66.7%), followed by rupture uterus 1 (16.7%) and placenta previa with placenta accreta 1 (16.7%). Maternal complications included febrile illness (50%) and anaemia (33.3%). All women, 6 (100%) required blood transfusions, 2(33.3%) cases transferred to ICU. No maternal deaths occurred. Conclusion: The leading indications for emergency peripartum hysterectomy in our study are uterine atony, placenta previa with placenta accreta and uterine rupture. The higher incidence of emergency peripartum hysterectomy is because of the higher prevalence of risk factors like multiparity, previous caesarean section and cesarean section in the index pregnancy. Proper antenatal care, early identification of risk factors and timely intervention by an obstetrician are necessary in preventing this disastrous event.
ABSTRACT
Objetivo: Analizar la experiencia clínica de pacientes sometidas a histerectomía posparto (HPP). Método: Estudio retrospectivo de la HPP efectuadas en Clínica Las Condes entre enero de 2000 y diciembre de 2009. Resultados: Hubo 15.356 partos con 34 casos de HPP (incidencia de 2,2 histerectomías/1000 partos). La edad materna promedio fue de 36 años; 97 por ciento eran multíparas. La edad gestacional promedio al parto fue 36,1 semanas (rango: 27-40). Causas principales: acretismo placentario (61,8 por ciento), inercia uterina (20,6 por ciento) y rotura uterina (8,8 por ciento). En el 29,4 por ciento se realizó además la ligadura de arterias hipogástricas. Histerectomía total en el 85,3 por ciento. El 91,2 por ciento presentó complicaciones, la más frecuente correspondió a lesión vesical asociada a acretismo placentario (26,5 por ciento). En el postoperatorio inmediato hubo 29 casos de anemia, 10 casos de coagulación intravascular diseminada, 2 casos de hemoperitoneo (reoperadas) y 2 pacientes con choque hipovolémico. Hubo 1 caso de trombosis pelviana, 1 caso de trombosis de vena ovárica y 1 caso de fasceitis necrotizante. Tardíamente hubo 3 casos de depresión, 1 tromboembolismo pulmonar, 1 fístula vésico-vaginal y 1 proceso inflamatorio pelviano. No hubo muertes maternas. Transfusión de sangre y/o hemoderivados en 76,5 por ciento. Hubo 1 mortinato y 2 mortineonatos con un 8,5 por ciento (3/35) de muerte perinatal. Conclusiones: La HPP es una intervención de urgencia que se plantea frente a una hemorragia severa, secundaria a diversas patologías, durante o posterior al parto, asociada frecuentemente con cesárea anterior e inercia uterina.
Objetive: To analyze the clinical experience of peripartum hysterectomy (PH). Method: Retrospective review of women who required PH at Las Condes Clinic since January 2000 to December 2009. Results: In the study period 15,356 patients were delivered with 34 cases of PH (incidence: 2.2/1000 deliveries). The mean age was 36 years old, 97 percent were multiparous. The mean gestational age at delivery was 36.1 weeks (range: 27-40). Causes: placenta accreta (61.8 percent), uterine atony (20.6 percent) and uterine rupture (8.8 percent). In 29.4 percent a bilateral hypogastric ligation was added to the hysterectomy. Total hysterectomy was performed in 85.3 percent of cases. There was at least one complication in 91.2 percent women. The intraopertive bladder injury associated with placenta accreta was the most frequent complication (26.5 percent). Postoperative complications: 29 cases of anemia, 10 cases of disseminated intravascular coagulopathy, 2 hemoperitoneum that required surgical reexploration, 2 cases of hypovolemic shock, 1 case of pelvic thrombosis, 1 case of ovarian vein thrombosis and 1 case of necrotizing fasceitis. Late complications included depression, pulmonary embolism, bladder-vagina fistula and pelvic inflammatory disease. 76.5 percent required transfusion. There were no cases of maternal death with 8.5 percent of perinatal death. Conclusions: PH it is performed in patients with severe bleeding during or after labor and delivery, frequently is associated with serious maternal morbidity. Previous cesarean section with abnormal placental implantation and uterine atony were the most frequent indications.
Subject(s)
Humans , Female , Pregnancy , Middle Aged , Hysterectomy/statistics & numerical data , Uterine Inertia/surgery , Placenta Accreta/surgery , Placenta Previa/surgery , Cesarean Section , Postoperative Complications/epidemiology , Gestational Age , Hemorrhage , Incidence , Maternal Age , Parity , Postpartum Period , Retrospective StudiesABSTRACT
OBJECTIVE: To investigate the clinical characteristics and associated risk factors for emergency peripartum hysterectomy classified by the amounts of blood loss. MATERIAL AND METHODS: We reviewed the medical records of 159 cases of peripartum hysterectomy among 46,666 deliveries, from Jan. 1995 to Dec. 2005 at the Dept. of Ob. & Gy. of Graduate School of Medicine, Gachon University of Medicine and Science. We divided the 159 cases into three groups based on the amounts of blood loss, which were group A as less than 2,000 mL of blood loss, group B as 2,000 to 4,000 mL of blood loss, and group C as more than 4,000 mL. The incidence, the type of delivery, the amounts of transfusion, the operative indication and the complications of peripartum hysterectomy were evaluated. RESULTS: The incidence of peripartum hysterectomy was 0.34% (159/46,666) and 0.47% in cases of cesarean section and 0.19% in vaginal delivery, respectively. There was no meaningful correlation between maternal age, parity, gestational age, hospital stay and amount of blood loss. The increments of blood loss correlated to the frequency of peripartum hysterectomy after cesarean section (p<0.05). The most common operative indication in group A was uterine atony (47.19%), and those in group B and C were adherent placentation (48.08%, 50.00%). Intraoperative and postoperative complications according to excessive bleeding were increased, and DIC, pulmonary infection, urethral and bladder injury were observed more frequently in group C than in group A. CONCLUSION: The emergency peripartum hysterectomy was related to adherent placentation and was accompanied with increased blood loss.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Dacarbazine , Emergencies , Gestational Age , Hemorrhage , Hysterectomy , Incidence , Length of Stay , Maternal Age , Medical Records , Parity , Peripartum Period , Placentation , Postoperative Complications , Risk Factors , Urinary Bladder , Uterine InertiaABSTRACT
We present a descriptive study of 86 pregnant women, who underwent peripartum hysterectomy at Siriraj Hospital between 1982 and 1992. The incidence was 0.5 per 1,000 deliveries. The indications leading to hysterectomy were uterine atony, uterine rupture, placenta previa, placenta accrete, tear bleeding, and uterine infection. Common complications were haemorrhage and infection. There were 6 maternal deaths (7%) from severe hemorrhage and all of them evinced coagulopathy. Furthermore, there were 9 fetal deaths (10.5%), 2 of them having congenital anomalies. This study indicates that lack of antenatal care, advanced maternal age multiparity, and abnormal delivery are the risk factors for peripartum hysterectomy. To reduce the prevalence and risk of peripartum hysterectomy; parity, appropriate maternal age at pregnancy, high quality antenatal care and good intrapartum care are factors to consider.