A clinical analysis of 10 cases of relaparotomy after emergency postpartum hysterectomy / 대한산부인과학회지

OBJECTIVE: To analysis the 10 cases of relaparotomy for intractable hemorrhage after emergency postpartum hysterectomy with massive transfusion. METHODS: Between January 1995 and December 2008, relaparotomies for intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy with massive transfusion were performed on 10 patients. Medical records were reviewed and detailed to collect clinical data including patients' clinical status, causes of bleeding, duration from hysterectomy to relaparotomy, bleeding sites, procedures for bleeding control, amount of transfusions, complications and prognosis. RESULTS: In relaparotomies, the points of bleeding were identified in all cases and multiple bleeding foci than one bleeding focus were found, and procedures for bleeding control were performed. In 8 cases, the bleeding were controlled successfully and these patients recovered without long term sequales. But in the other 2 cases, although the bleeding controls were successful during relaparotomy and bleeding amount decreased after relaparotomy, but bleeding amount increased the next day and angiographic embolizations were performed. These patients died due to multi-organ failure and continued bleeding. In one of these cases, the endotracheal intubation had been done on arrival at our hospital with postpartum hemorrhage after vaginal delivery at private clinic. In another case, the cardiopulmonary resuscitation was performed on arriving at our hospital with intractable bleeding after postpartum subtotal hysterectomy in other hospital. CONCLUSION: In most cases, bleeding controls for intractable bleeding after postpartum hysterectomy were successful during and after relaparotomy in spite of development of dilutional coagulopthy due to massive transfusion, and resulted in rapid recovery and good prognosis. Even though dilutional coagulopthy was developed because of massive transfusion, relaparotomy was safe and effective procedure for management of intractable hemorrhage after emergency postpartum hysterectomy with clotting factor replacement. If personnel and adequate clotting factor replacement are available, relaparotomy should not be delayed for management of intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy.

Indicaciones, complicaciones y factores asociados de la histerectomía posparto: Maternidad Enrique C. Sotomayor / Indications, complications and factors associated in postpartum hysterectomy: Enrique C. Sotomayor Maternity Hospital

Tipo de estudio: descriptivo, retrospectivo, longitudinal. Objetivo: Determinar las principales indicaciones, complicaciones y factores asociados de la Histerectomía posparto en el hospital maternidad “Enrique C. Sotomayor”, período 2003 – 2004. Materiales y métodos: El Universo lo constituyen 176 pacientes a quienes se les realizó histerectomía Posparto. Del Universo se tomó una muestra de forma aleatorizada de 89 pacientes tomando como referencia 5% de error y una confiabilidad de 95%. Resultados: Las principales indicaciones fueron el acretismo placentario (26%), y la atonía uterina (14%). La complicación más frecuente fue la anemia (25%) seguida de hemorragia (23%). Los factores asociados más importantes fueron edad materna avanzada, la operación cesárea como vía de finalización del embarazo y antecedentes de HTA. Conclusiones: En la actualidad la histerectomía posparto se realiza como el último esfuerzo quirúrgico para detener una hemorragia incoercible. La incidencia de este procedimiento es alta en nuestro medio, por lo que se debe protocolizar en todas las instituciones de salud el manejo del tercer período del parto.

Type of study: Descriptive, Retrospective, and Longitudinal. Objetive: To determinate the indications, complications and factors associated in the postpartum hysterectomy at the “Enrique C. Sotomayor” Maternity Hospital during the period 2003-2004. Materials and methods: The Universe constitutes 176 patients who underwent postpartum hysterectomy. From this universe 89 patients were randomly chosen. Results: Indications for this procedure are placenta accreta (26%) and uterine atony (14%). The most frequent complication was anemia (25%) and hemorrhage (23%) Factors found associated with postpartum hysterectomy were increasing maternal age, underwent c-section and history of hypertension. Conclusions: Currently, postpartum hysterectomy is done as a last resort to stop postpartum hemorrhage. The incidence of this procedure is very high in our society, therefore, it is suggested that a protocol should be down in the management of third stage of delivery.

Clinical Analysis on Emergency Postpartum Hysterectomy / 대한주산의학회잡지

OBJECTIVE: To analyze incidence, indications, risk factors, complications, and neonatal outcomes of emergency postpartum hysterectomies performed at EulJi University Medical Center. METHODS: A retrospective study of all cases of postpartum hysterectomies between May. 1996 and Dec. 2000. was carried out. RESULTS: 37 cases of postpartum hysterectomies during this period were performed, for overall incidnce of 2.3 per 1000 deliveries. Incidence after vaginal delivery and cesarean section was 0.03% and 0.52% respectively. The rate of postpartum hysterectomy increased with increasing age and parity. The main indications were placental disorders(54.1%) including placenta previa and adherent placenta, uterine atony(37.8%), uterine myoma(5.4%) and uterine rupture(2.7%) in order. The relative risk of postpartum hysterectomy according to the risk factors was 97.6(95% confidence interval 52.17-184.06) for placental disorders, 16.3(95% confidence interval 4.94-52.31) for cesarean section and 2.4(95% confidence interval 1.21-4.76) for previous cesarean section. The mean amount of transfuion was 17.1 pints. Although no maternal mortality had occurred, 16 patients(43.2%) had complica-ions including respiratory complication(13.5%), hemorrhagic complication(10.8%), infection(8.1%) and urologic injury(8.1%). Regarding fetal outcome, 2 of 38 infants(1 case, twin) were stillborn (5.3%) and 10 infants(26.3%) were suffered from various illness including prematurity, sepsis, meningitis, and brain hemorrhage. CONCLUSION: The data identifies placental disorders are the leading cause of postpartum hysterectomy. Although postpartum hysterectomy is a necessary life-saving operation, maternal morbidity remained high.