INVESTIGACIÓN DE LA INCIDENCIA Y COMPLICACIONES DEL PERIPARTO DE EMERGENCIA HISTERECTOMÍA / 9 INVESTIGATION OF INCIDENCE AND COMPLICATIONS OF EMERGENCY PERIPARTUM HYSTERECTOMY

Introduction: The emergency peripartum hysterectomy is a high-risk surgery, which is mostly performed after vaginal delivery or Cesarean 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 cesarean 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.

Role of Emergency Hysterectomy in Modern Obstetrics.

A retrospective study was done to estimate prevlance, indications and complications of emergency hysterectomy done for various obstetric indications over two years was carried out. There were 37549 confinements during study period from April 2006 to Aug 2008. Out of this 27213 (72.4%) delivered vaginally and 10336 (27.5%) by Cesarean section. 80 emergency hysterectomies were done, incidence being 2.13 /1000 births. Mean age was 30.5 years. Majority (75%) were from rural areas. Maximum cases were para 2-4. Most common indication for emergency hysterectomy was uterine rupture (40%) followed by atonic PPH (28.75%). Placenta previa (9%). Secondary PPH (6.25%), broad ligament hematoma (6.2%) placenta accreta &increta (2%).fibroid with bleeding (3.7%). Couvelaire uterus (2.1%) and obstructed labour with septicemia (1.2%). Majority of uterine rupture cases were late referrals from rural areas. Out of 32 cases of rupture uterus 20 were with previous LSCS and 12 were multipara. Maternal mortality was 2.5% and the cause of death was related to irreversible shock and DIC. Identification of high risk cases, early referral and procedures like internal illiac artery ligation can reduce the incidence of Emergency Hysterectomy.

Peripartum hysterectomy in RIPAS Hospital: Experience over an 11-year period

Introduction: Peripartum hysterectomy refers to hysterectomy that is performed for complications of vaginal delivery or during caesarean section. A common reason for peripartum hysterectomy is post partum haemorrhage (PPH). The aim of this study is to assess the incidence, indications and risk factors for emergency peripartum hysterectomy carried out at RIPAS hospital over an 11-year period. Materials and Methods: Patients who had undergone emergency peripartum hysterectomy over this 11-year (1999-2009) period were identified from the operation registry and the medical records were retrospectively reviewed. Data on maternal age, parity, gestational age, indication for peripartum hysterectomy, the type of operation performed and estimated blood loss were collected.Results: During the study period, there were a total of 59,974 deliveries (83.8% vaginal deliveries and 16.2% caesarean section deliveries) and 6,530 emergency obstetric surgeries. There were a total of 33 emergency peripartum hysterectomies performed accounting for 0.5% of all emergency obstetric surgeries performed. This translated to an overall incidence rate of 5.5 peripartum hysterectomies per 10,000 deliveries: 1.2 per 10,000 vaginal deliveries (n=6) and 27.9 per 10,000 caesarean sections deliveries (n=27). All peripartum hysterectomies were performed for massive PPH. The most common underlying pathology was placenta praevia (57.57%)followed by uterine atony. The risk for peripartum hysterectomy was high if placenta praevia was associated with previous scarred uterus as there is more chance of accreta. Conclusion: Our peripartum hysterectomy rate is comparable to what has been reported in the literature. The rate was higher for caesarean section deliveries. All peripartum hysterectomies were performed for PPH.

A Clinical Study on Peripartum Emergency Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: Peripartum emergency cesarean hysterectomy of 28 cases at our hospital for 10years were reviewed that the clinical indication, history, and annual incidence change. METHODS: A retrospective descriptive analysis from January, 1988 to December, 1997 was carried out. RESULTS: There were 28 cases of emergency cesarean hysterectomy identified during this period among total 24, 689 deliveries. The annual incidence of emergency cesarean hysterectomy was significantly declined statistically(p<0.005). Cesarean hysterectomy was performed in 20 of 6, 671 cesarean section(0.30%) and in 8 of 18, 018 vaginal deliveries(0.04%), so more frequently after cesarean section than vaginal delivery. The cesarean hysterectomy rate was more frequent in multiparous women(0, 22%) than in nulliparous women(0, 02%). The most common indication of cesarean hysterectomy was 13 cases of uterine atony(46%), followed by 5 cases uterine rupture(18%), 5 cases of placenta previa with placenta accreta(18%), 3 cases of placenta previa(11%), 2 cases of uterine myoma(7%). No significant difference in length of operating time, amount of blood loss and operative complications were found between total abdominal hysterectomy and subtotal hysterectomy. The all patient who had cesarean hysterectomy recieved from 1200ml to 15840ml of blood transfusion with a mean of 3673ml. In aspect of fetal outcome, 3 cases of FDIU(Fetal death in utero) in uterine rupture and 1 case of stillbirth in preterm were found. The maternal complications were wound disruption, DIC, wound hematoma, ureter injury, vaginal stump bleeding, UTI(Urinary tract infection) and retroperitoneal bleeding, CONCLUSION: We conclude that the incidence of emergency cesarean hysterectomy declined with prediction of antenatal risk factor, preparing of sufficient fresh blood, prophylactic antibiotics, vigorous uterotonics and close observation after delivery.