ABSTRACT
OBJECTIVE: The aim of this study was to compare operative and postpartum outcomes between planned and emergent cesarean hysterectomy. STUDY DESIGN: In this multicenter retrospective review over a 5-year period, 65 cases of cesarean hysterectomy (30 planned vs 35 emergent) were identified. Demographic, operative, and postoperative data were extracted and stratified by group (planned vs emergent). RESULTS: Patients who underwent an emergent cesarean hysterectomy were more likely to have higher estimated blood loss (2597.1 +/- 1369.4 mL vs 1963.3 +/- 1180.2 mL; P = .05), have transfusion (66% vs 33%; P = .02), and require greater quantities of packed red blood cells (4.49 +/- 4.7 x10(12)/L vs 1.6 +/- 3.1 x10(12)/L; P = .006) compared with the planned cesarean hysterectomy group. Patients who underwent emergent cesarean hysterectomy had higher overall complication rates (37% vs 66%; P = .03) and more intensive care unit admissions (7% vs 29%; P = .03). CONCLUSION: After planned cesarean hysterectomy, patients had a significantly lower rate of blood loss, less need for blood transfusions, and fewer complications compared with patients who underwent an emergent cesarean hysterectomy.
Subject(s)
Cesarean Section , Hysterectomy , Adult , Female , Humans , Infant, Newborn , Pregnancy , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
BACKGROUND: Thrombotic thrombocytopenic purpura rarely presents during late pregnancy or immediately postpartum. This report describes the clinical course of a patient considered to have hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome but later determined to have thrombotic thrombocytopenic purpura. CASE: At 37 weeks of gestation, a multiparous woman was diagnosed with HELLP syndrome. She received high-dose dexamethasone, magnesium, antihypertensives, and platelets before delivery. Over the next 36 hours, renal function acutely worsened and death ensued. One week after death a plasma ADAMTS13 activity of 4% was reported. CONCLUSION: Thrombotic thrombocytopenic purpura can mimic HELLP syndrome late in gestation. Lack of response to dexamethasone within 12-24 hours and atypical relationships among laboratory values are two clues that thrombotic thrombocytopenic purpura may be the underlying pathology and that plasma exchange is emergently needed.