ABSTRACT
BACKGROUND: Our objective was to identify the risk factors associated with placenta accreta. METHODS: Cases of peripartum hysterectomy at University Hospital of Bratislava were identified in the period from January 1st 2008 to December 31th 2013. Included were only those cases which had a histological evidence of placenta accreta. RESULTS: Fifty patients, who underwent peripartum hysterectomy were included in the study. Between 2008 and 2013 eight cases of placenta accreta were identified. Five (62.5 %) of these were suspected before delivery. The overall incidence of PA was 0.19 per 1000 deliveries. Median gestational age at delivery was 37 weeks (range 25-41 weeks). Six of eight (75 %) women with placenta accreta had a previous caesarean delivery or curettage. In 5 patients both placenta praevia and prior Caesarean delivery were present. Among the 50 women who underwent peripartum hysterectomy, 8 (16 %) were patients with both prenatally diagnosed placenta praevia and previous caesarean delivery, placenta accreta was suspected in 4 of these (50 %) compared with 10 of 42 (24 %) without this combination of risk factors. CONCLUSIONS: Those in whom placenta accreta was suspected were delivered earlier than 37 weeks of gestation and were less likely to have emergency delivery. Placenta accreta is the second most common indication for an emergency peripartum hysterectomy. There is a high suspicion of placenta accreta in patients with placenta praevia and after previous Caesarean section (Tab. 3, Ref. 17).
Subject(s)
Cesarean Section , Hysterectomy , Placenta Accreta , Adult , Cesarean Section/adverse effects , Cesarean Section/statistics & numerical data , Emergencies , Female , Hospitals, University/statistics & numerical data , Humans , Hysterectomy/methods , Hysterectomy/statistics & numerical data , Incidence , Middle Aged , Outcome Assessment, Health Care , Peripartum Period , Placenta Accreta/pathology , Placenta Accreta/surgery , Placenta Previa/diagnosis , Placenta Previa/surgery , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/prevention & control , Pregnancy , Retrospective Studies , Risk Factors , SlovakiaABSTRACT
The article presents the results of examination and surgery of 185 patients with degenerative diseases as well as with a cervical spine trauma. The circulatory disturbance of the vertebral artery took place in all patients. A different degree of changes was observed in color duplex scanning. There were minor circulatory disturbances, course deformations (angular, C, S, V-shaped twists) and dissection of the vertebral artery. Color duplex scanning allowed estimating of local and system hemodynamic significance of extravasal influences. The strategy of treatment and volume of surgical interference were defined by the degree of circulatory disturbance in the vertebral artery.
Subject(s)
Cervical Vertebrae , Neurodegenerative Diseases , Neurosurgical Procedures/methods , Spinal Cord Injuries , Vertebrobasilar Insufficiency , Adult , Cervical Vertebrae/injuries , Cervical Vertebrae/pathology , Decompression, Surgical/methods , Disease Management , Female , Hemodynamics , Humans , Male , Middle Aged , Neurodegenerative Diseases/complications , Neurodegenerative Diseases/diagnosis , Neurodegenerative Diseases/physiopathology , Neurodegenerative Diseases/surgery , Neurologic Examination , Spinal Cord Injuries/complications , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/surgery , Treatment Outcome , Ultrasonography, Doppler, Color , Vertebral Artery/diagnostic imaging , Vertebrobasilar Insufficiency/diagnosis , Vertebrobasilar Insufficiency/etiology , Vertebrobasilar Insufficiency/physiopathology , Vertebrobasilar Insufficiency/therapyABSTRACT
The purpose of this study was to determine the frequency, indications, complications and risk factors associated with peripartum hysterectomy carried out at our clinical department between 1st January 2008 and 31th December 2012. Peripartum hysterectomy was defined as a hysterectomy performed less than 48 hours after delivery. Clinical characteristic and obstetric histories were retrospectively reviewed between 5 years. There were 20 emergency peripartum hysterectomies among 13 660 deliveries at our department. The overall rate of peripartum hysterectomy was 1,46 per 1000 deliveries. The primary indications for hysterectomy were uncontrolled bleeding caused by uterine hypotony (45%), followed by placenta praevia (25%). Other indications were placental abruption (15%), pelvic endometriosis (5%), placenta increta (5%) and uterus myomatosus (5 %). The incidence of peripartum hysterectomy increased 2-fold in cases of placental patology, and 17-fold in cases of uterine hypotony. Overall, 95% of hysterectomy patients required transfusions.
