What is new in peripartum hysterectomy? A seventeen year experience in a tertiary hospital

Emergency peripartum hysterectomy (EPH) is a major obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH). The medical records of 13 patients who had undergone EPH, between January 2012 and December 2018, were reviewed retrospectively. All necessary data was obtained by record review. The mean age of pregnant women was 30 year. There were 13 EPHs out of 15768 deliveries, a rate of 0.82 per 1,000 deliveries. Out of 13 women who underwent EPHs, 8 hysterectomies were performed after cesarean delivery and 5 after vaginal delivery. The most common indication for hysterectomy was abnormal placentation (7/13), followed by atony (4/13), rupture of scared uterus (1/13) and rupture of unscared uterus (1/13). There were two cases of intra-operative bladder injury, we had 1/13 maternal death because of EPH. There were no cases of neonatal mortality. In our series, abnormal placentation was the most common of indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.

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Associations among Discharge Opioid Prescribing and Inpatient Postpartum Opioid Usage after Delivery

American Journal of Perinatology Reports ◽

10.1055/s-0040-1716906 ◽

2020 ◽

Vol 10 (03) ◽

pp. e275-e280

Author(s):

Ashley Veade ◽

Tyler McKinnish ◽

Ebony Carter ◽

Adam Lewkowitz

Keyword(s):

Odds Ratio ◽

Retrospective Cohort ◽

Primary Outcome ◽

Tertiary Hospital ◽

Opioid Use Disorder ◽

Opioid Consumption ◽

Wound Complications ◽

Opioid Use ◽

Peripartum Hysterectomy ◽

Discharge Outcomes

Abstract Objective The aim of the study is to identify an association between inpatient opioid consumption and prescription at discharge after vaginal delivery (VD) and cesarean delivery (CD). Methods This retrospective cohort study included women with an active inpatient opioid order after VD or CD between July and October of 2018 at a single academic tertiary hospital. Women with opioid use disorder, 3rd or 4th degree lacerations, wound complications, and peripartum hysterectomy were excluded. Oxycodone 5-mg (mg) tablets consumed postpartum and prescribed at discharge and sociodemographics were recorded. Primary outcome was the number of oxycodone 5-mg tablets prescribed at discharge. Outcomes were analyzed using multivariable logistic regression between quartiles of inpatient opioid consumption. Results A total of 437 patients were included: 169 patients underwent VD, and 268 underwent CD. For VD and CD, women in the highest quartile of inpatient opioid consumption were more likely Black compared with the lowest quartile (p = 0.006 and p = 0.004, respectively). No association existed between inpatient opioid use and number of tablets prescribed at discharge for VD or CD (odds ratio [OR] 0.22 [95% confidence interval or CI 0.02–2.17] and OR 1.04 [95% CI 0.85–1.32], respectively). Conclusion The number of opioid tablets prescribed at discharge had no association with inpatient postpartum consumption after VD or CD.

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Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

Pan African Medical Journal ◽

10.11604/pamj.2013.15.60.1879 ◽

2013 ◽

Vol 15 ◽

Cited By ~ 16

Author(s):

Aniekan Monday Abasiattai ◽

Aniefiok Jackson Umoiyoho ◽

Ntiense Maurice Utuk ◽

Emmanuel Columba Inyang-Etoh ◽

Otobong Peter Asuquo

Keyword(s):

Tertiary Hospital ◽

Peripartum Hysterectomy ◽

Southern Nigeria ◽

Emergency Peripartum Hysterectomy

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Study of maternal outcome in emergency peripartum hysterectomy at a tertiary hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175289 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5602

Author(s):

Varalakshmi K. ◽

Radha Rastogi ◽

Neha Choudhary

Keyword(s):

Clinical Judgment ◽

Care Center ◽

Tertiary Care ◽

Tertiary Hospital ◽

Maternal Outcome ◽

Peripartum Hysterectomy ◽

Difficult Decision ◽

Life Saving ◽

Emergency Peripartum Hysterectomy ◽

Emergency Hysterectomy

Background: Emergency peripartum hysterectomy is an indispensable part of the obstetricians' armamentarium. In no other gynecological or obstetrical surgery, is the surgeon in as much a dilemma as when deciding to resort to an emergency hysterectomy. On one hand, it is the last resort to save a woman's life and on the other hand, her reproductive capability is sacrificed. Many times, it is a very difficult decision and requires good clinical judgment. Objective of present study was to study the cases of emergency peripartum hysterectomy performed in tertiary care center to estimate the incidence, indications, and maternal outcome following the procedure.Methods: All cases of peripartum emergency hysterectomy that were performed in our hospital from January 2015 to June 2016 were reviewed and evaluated in terms of the incidence, indications, and the associated complications.Results: During the study period there were 28 emergency peripartum hysterectomies out of 28215 deliveries giving an incidence of 0.10%. rupture uterus was the Commonest indication contributing to 13 cases. Septicemia was the common post operative complication associated. There were 4 maternal deaths in our study.Conclusions: Emergency peripartum hysterectomy though a rare operation, still remains a life‑saving procedure with which every obstetrician must be conversant. regular antenatal care, identification of high‑risk cases, and prompt referral can reduce the incidence of this operation. Peripartum hysterectomy will always remain an essential life saving surgery for the mother at cost of their uterus and when performed in indicated cases at right time will help in bringing down maternal mortality.

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Emergency peripartum hysterectomy in a tertiary hospital in Ankara, Turkey: a 5-year review

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-012-2434-z ◽

2012 ◽

Vol 286 (5) ◽

pp. 1131-1134 ◽

Cited By ~ 14

Author(s):

Omer Lutfi Tapisiz ◽

Sadiman Kiykac Altinbas ◽

Bulent Yirci ◽

Pinar Cenksoy ◽

Aski Ellibes Kaya ◽

...

Keyword(s):

Tertiary Hospital ◽

Peripartum Hysterectomy ◽

Emergency Peripartum Hysterectomy

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Emergency peripartum hysterectomy in a tertiary hospital in Antananarivo, Madagascar

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184542 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4752

Author(s):

Ratsiatosika A. Tanjona ◽

Randriamahavonjy Romuald ◽

Ratongasoa Mahefa ◽

Housni I. A. ◽

Rakotonirina A. Martial ◽

...

Keyword(s):

Postpartum Hemorrhage ◽

Tertiary Hospital ◽

Uterine Atony ◽

University Hospital ◽

Maternal Complications ◽

Peripartum Hysterectomy ◽

Third Stage ◽

Emergency Peripartum Hysterectomy ◽

Delivery Route ◽

Epidemiological Profile

Background: Postpartum hemorrhage is one of the leading causes of maternal death in the entire world. It affects 10% of deliveries. Emergency peripartum hysterectomy (EPH)defined as a lifesaving procedure involving the removal of the uterus to treat severe postpartum hemorrhage is one of the last-resort treatments for severe postpartum hemorrhage in case of failure of other techniques. Through this study, we aimed both to describe the epidemiological profile, to determine the etiologies, and maternal complications of EPH.Methods: It is about a descriptive retrospective study from January 1st, 2016 to January 1st, 2017 at the Befelatanana University Hospital of Obstetrics and Gynecology. We included all patients who underwent Emergency peripartum hysterectomy after 22 weeks of Amenorrhea (WA) regardless of the delivery route in the centre. We used the R software for the statistical analysis of the results.Results: We had 31 cases of EPH during this period with a prevalence of 0.44%. The average age was 26.38±5.61 years. Mean gestational age was 37±3.59 weeks of amenorrhea. In the 83.87% of cases, the patient received less than four prenatal consultations. Patients were referred in 45.16% of the cases. The delivery route was by cesarean section in 48.39% of cases. Eleven patients (35.48%) received a blood transfusion. Hysterectomy was subtotal in 96.77% of the cases. We had five (16.13%) maternal deaths during the study period. The leading cause of death was hemorrhagic shock (80%). The etiology of hysterectomy was dominated by uterine atony complicated by hemorrhage (48.39%), followed by retroplacental hematoma (25.81%) and uterine rupture (22.58%).Conclusions: EPH still holds its place in the management of postpartum hemorrhage in Madagascar. Maternal mortality remains high. Uterine atony was the most common indication for EPH. The prevention of postpartum hemorrhage by management of the third stage of labour should be carried out by any health actor.

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