Clinical analysis of emergency peripartum hysterectomies in a tertiary center.

OBJECTIVE: To investigate the incidence, indications, complications, and risk factors associated with increased mortality and morbidity of emergency peripartum hysterectomy (EPH). MATERIALS AND METHODS: The authors retrospectively analyzed 48 cases of EPH performed within six-year interval at Ondokuz Mayis University Hospital. EPH was defined as the operation performed for life-threatening hemorrhage which could not be controlled with conservative treatment modalities within 24 hours of a delivery. RESULTS: The incidence of EPH was 5.03 per 1,000 deliveries. The most common indication for EPH was abnormal placental adherence (n = 22, 45.8%), followed by uter- ine atony (n = 19, 39.6%). All the patients with placenta accreta had a history of repeat cesarian section (CS) and placenta previa.Total hysterectomy was performed in almost all of the patients (n = 47, 97.9%). All women required blood transfusions. Maternal morbidity was significant, with bladder injury (31.3%) and disseminated intravascular coagulation (18.7%) among the most common complications. There were one maternal (2.1%) and five neonatal deaths (10.4%). CONCLUSION: Since most of the EPH cases are associated with prior cesarean delivery, decision of the first CS should be made for true obstetrical indications.If conservative treatments fail to control massive obstetrical bleeding, blood products and an experienced obstetrician should be ready to perform EPH to decrease the maternal mor- bidity and mortality.

Stereological and histopathological evaluation of ovary and uterine horns of female rats prenatally exposed to diclofenac sodium.

In this study, we investigated the morphometric and histological alterations of the ovary and uterine horns in 4-week-old rats that were prenatally exposed to diclofenac sodium (DS). For this purpose, pregnant rats were divided into two groups: the control and drug-treated groups. Beginning from the 5th day after mating through the 15th day of pregnancy, DS (1 mg/kg daily) was intraperitoneally injected in the treated group. No injection was given to the rats in the control group. After spontaneous delivery, male offspring were obtained. At the end of the 4th week, ovary and uterine horn samples were removed. Following dissection and routine histological preparation, histopathological and stereological investigations were carried out. Our results indicate that DS application leads to a decrease in the mean volume fraction of the uterine horn. Moreover, there was an increased volume fraction in some structures of the ovary; like the cortex, medulla and zona granulosa. There was no difference found between the two groups in terms of the mean volume of the antrum and the Graafian follicle fraction. Finally, in light of our findings, we may suggest that DS may lead to adverse effects in rats that are prenatally subjected to this drug.