Investigación de incidencia y complicaciones de histerectomía de emergencia en periparto / Investigation of Incidence and Complications of Emergency peripartum hysterectomy

Introducción: La histerectomía periparto de emergencia es una cirugía de alto riesgo, que se realiza mayoritariamente después de un parto vaginal o cesárea. Dada la importancia de las complicaciones y la mortalidad de las embarazadas para el sistema de salud, el presente estudio tuvo como objetivo investigar la incidencia y las complicaciones de la histerectomía periparto de emergencia en los hospitales generales y docentes de la Universidad de Ciencias Médicas de Zahedan. Materiales y Métodos: En este estudio descriptivo-analítico transversal, luego de obtener la aprobación del Comité de Ética, se investigó la historia clínica de las pacientes con histerectomía periparto de emergencia ingresadas en el hospital Ali ibn Abitaleb de Zahedan para la interrupción del embarazo durante 2017-2018. fueron estudiados. Después de evaluar las características demográficas, incluida la edad, la educación y la ocupación, se investigaron las causas y las complicaciones de la histerectomía de emergencia. Finalmente, los datos fueron analizados por el software SPSS.Resultados: De 2438 casos, se investigaron 50 casos de histerectomía. La edad media de las madres y el número medio de embarazos fue de 31,06 ± 5,21 y 5,72 ± 2,31, respectivamente. En este estudio, se registraron 35 cesáreas (70%) y 15 partos vaginales normales (30%), y solo el 2% condujo a una histerectomía de emergencia. Las causas más comunes de histerectomía de emergencia incluyeron placenta accreta (28%), atonía uterina (24%) y rotura uterina (20%). Las complicaciones también incluyeron fiebre (24%), coagulopatía (14%) e infección de la herida (12%). Conclusión: la placenta accreta y la atonía uterina son las causas más importantes de histerectomía. Las complicaciones más comunes de la histerectomía de emergencia son fiebre, coagulopatía e infecciones de heridas. Una disminución en el parto por cesárea electiva y un mayor fomento del parto vaginal natural podrían reducir significativamente la incidencia de histerectomía periparto y la mortalidad materna

Introduction: The emergency peripartum hysterectomy is a high-risk surgery, which is mostly performed after vaginal delivery or Caesarean section. Given the importance of complications and mortality of pregnant mothers for the health system, the present study aimed to investigate the incidence and complications of emergency peripartum hysterectomy in general and teaching hospitals of Zahedan University of Medical Sciences. Materials and Methods: In this cross-sectional descriptive-analytic study, after obtaining the Ethics Committee approval, the medical record of patients with emergency peripartum hysterectomy admitted to Ali ibn Abitaleb hospital of Zahedan for pregnancy termination during 2017-2018 were investigated. were studied. After evaluating demographic characteristics, including age, education, and occupation, causes, and complications of emergency hysterectomy were investigated. Finally, data were analyzed by SPSS software. Results: Out of 2438 cases, 50 cases of hysterectomy were investigated. The mean age of mothers and the average number of pregnancies was 31.06±5.21 and 5.72±2.31, respectively. In this study, 35 caesarean sections (70%) and 15 normal vaginal delivery (30%) were recorded, with only 2% leading to emergency hysterectomy. The most common causes of emergency hysterectomy included placenta accreta (28%), uterine atony (24%), and uterine rupture (20%). The complications also included fever (24%), coagulopathy (14%), and wound infection (12%). Conclusion: Placenta accreta and uterine atony are the most important causes of hysterectomy. The most common complications of emergency hysterectomy are fever, coagulopathy, and wound infections. A decrease in elective caesarean delivery and further encouraging to natural vaginal delivery could significantly reduce the incidence of peripartum hysterectomy and maternal mortality

Costs and mortality rates of surgical approaches to hysterectomy in Brazil

ABSTRACT OBJECTIVE To analyze the costs of hysterectomies performed in Brazil due to benign conditions, and to assess its hospital admittance and mortality rates. METHODS A retrospective cohort was carried out from January 2010 to December 2014, analyzing all hysterectomies (n = 428,346) registered on the DATASUS database between January 2010 and December 2014. Data were collected through a structured questionnaire and analyzed using the SPSS 20.0 for Windows. RESULTS Hospital admissions were 300,231 for total abdominal hysterectomies, 46,056 for vaginal hysterectomies, 29,959 for subtotal abdominal hysterectomies and 1,522 for laparoscopic hysterectomies. Mortality rates were 0.26%, 0.09%, 0.07% and 0.05% for subtotal, total abdominal, laparoscopic, and vaginal hysterectomies, respectively. Among the procedures studied, total abdominal hysterectomies had the most costs (R$217,802,574.77), followed by vaginal hysterectomies (R$24,173,490.00), subtotal abdominal hysterectomies (R$19.253.300,00) and laparoscopic hysterectomies (R$794,680.40). CONCLUSIONS Total abdominal hysterectomies had the highest overall costs mainly because it was the most commonly performed technique. Mortality rates were greatest in subtotal abdominal hysterectomies; this, however, may be due to bias related to missing data in our database.

outcome of subtotal abdominal hysterectomy

To determine the outcome of subtotal abdominal hysterectomy in terms of intraoperative and postoperative complications in women with benign uterine conditions. Descriptive study. The Jinnah Medical and Dental College and Hospital, Karachi from March, 2003 to March, 2004. The study included 50 women, who underwent subtotal abdominal hysterectomy due to technical difficulties during surgery in benign uterine diseases. Inclusion criteria were menorrhagia and pelvic pain, dysfunctional uterine bleeding, repeated pelvic infection refractory to medical treatment, fibroid uterus and ovarian cyst with adenomyosis of uterus. Patients over 60 years of age, uterine prolapse and suspected cancer of cervix were excluded. Detailed history was taken and examination done. Routine investigations including ultrasound were carried out. Subtotal hysterectomy was performed by clamp-cut and ligate method. The mean age of patients undergoing hysterectomy was 44 years and parity between 4 - 10. Most common complaint was excessive menstrual loss. Fibroid was found in 10 [20%] cases, dysfuntional uterine bleeding in 15[30%], pelvic pain and menorrhagia in 5[10%], ovarian cyst with adenomyosis in 13[26%] and repeated pelvic infections refractory to medical treatment in 7[14%].There was no injury to adjacent vicera during the procedure .Early complications like temperature was noted in 5[10%] and late complications like cyclical menstrual bleeding in 1[2%] and vaginal discharge in 2[4%] patients. All cases were followed-up 3 and 6 monthly and urinary, sexual and bowel functions were found to be unaffected during this period. There was no mortality associated with the procedure. The histopathology of specimen revealed fibroid followed by adenomyosis to be the commonest pathology. Subtotal abdominal hysterectomy resulted in less operative time, rapid recovery, fewer short-term complications but infrequently caused cyclical bleeding and vaginal discharge

Histerectomía obstétrica (1984-1995) / Obstetrical hysterectomy (1984-1995)

Objetivo. Conocer la incidencia, factores relacionados y repercusiones de la histerectomía obstétrica. Método. Estudio retrospectivo, descriptivo de 60 histerectomías realizadas entre 1984 y 1995, en 52817 casos obstétricos. Ambiente. Hospital Dr."Adolfo Prince Lara", Puerto Cabello Edo. Carabobo. Resultados. La frecuencia fue de 0,10 por ciento o de 1x880. La edad materna varió entre menos de 19 años y más de 40; hubo 11 a 19 o menos años (18,33 por ciento); Doce eran primigestas y 11 grandes multiparas. La principal indicación fue la sepsis, con 26 casos (12 posaborto, 9 poscesárea y 5 posparto), seguida por la atonía uterina, 21 casos, y la rotura o dehiscencia de la cicatriz, 12. Como complicaciones figuraron: anemia (75 por ciento), infecciones de la herida (13,33 por ciento) y 6 muertes maternas(10 por ciento). Conclusión. Se necesita estrategia de ataque séptico y mejora de las condiciones de asepsia y antisepsia del acto obstétrico

Qual a influência do quadro clínico na histerectomia realizada durante o ciclo grávido-puerperal? / What is the influence of clinical picture in the hysterectomy performed during the pregnant-puerperal period?

Com o objetivo de avaliar a influência do quadro clínico e da época do ciclo grávido-puerperal na histerectomia realizada nesta fase, analizaram-se 85 casos ocorridos entre janeiro/78 e agosto/89, no Hosppital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da Universidade de Säo Paulo. O material foi dividido em três grupos. No grupo I têm-se as histerectomias realizadas nas primeiras 24 semanas de gestaçäo, sendo o abortamento séptico respons vel por 22 (88 por cento) das 25 histerectomias. No grupo II, que é composto por histerectomia ces rea de ablaçäo uterina até uma hora pós-parto, houve 23 histerectomias, todas por síndrome hemorrágica. No último grupo, têm-se 37 histerectomias, sendo que 20 (54 por cento) por síndrome infecciosa e o restante por síndrome hemorrágica. Verificou-se nos resultados que o grupo II necessitou de menor tempo de internaçäo pós-cirúrgica e menor quatidade de transfusäo sangüínea no intra e pós-operatório, embora o tempo cirúrgico e o número de complicaçöes tenham sido maior que os demais. Conclui-se que a rapidez da indicaçäo da histerectomia é importante para o melhor prognóstico das pacientes.