Risk factors for emergency peripartum hysterectomy - An experience of a developing country

2000 ◽  
Vol 70 ◽  
pp. B91-B91
Author(s):  
S. Rou ◽  
N. Nasrin ◽  
J. Begum ◽  
R. Begum ◽  
A. Begum
2014 ◽  
Vol 52 (193) ◽  
pp. 668-676 ◽  
Author(s):  
Meena Pradhan ◽  
Yong Shao

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.


Author(s):  
Manjula S. K. ◽  
Suvarchala Katakam ◽  
Shobha G.

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.


2015 ◽  
Vol 43 (6) ◽  
Author(s):  
Georg Macharey ◽  
Veli-Matti Ulander ◽  
Karel Kostev ◽  
Mervi Väisänen-Tommiska ◽  
Volker Ziller

AbstractThis study aims to estimate the occurrence of emergency peripartum hysterectomy (EPH) and to quantify its risk factors in connection with the mode of delivery and the obstetric history of patients at the Helsinki University Central Hospital, Finland.In a retrospective, matched case-control study we identified 124 cases of EPH from 2000 to 2010 at our hospital. These were matched with 248 control patients.The incidence rate of EPH was 9.9/10,000. Patients whose current delivery was vaginal, and had a cesarean section (CS) in their history had a six-fold risk for EPH. Women who underwent their first CS had a nine times higher risk, while patients who currently underwent CS and had a history of previous CS, had a 22 times higher risk. Those who experienced prostaglandin-EObstetric emergency training and guidelines for massive hemorrhage should be established in any delivery department. Moreover, all possible precautions should be taken to avoid the first CS if it is obstetrically unnecessary. Induction with prostaglandin-E


Author(s):  
Anitha E. ◽  
Ramalakshmi S.

Background: Peripartum hysterectomy is a life-saving obstetric procedure that is performed at the time of a caesarean section or postpartum following either vaginal delivery or caesarean section. The purpose of the present study was to determine the incidence, risk factors ,indications ,maternal and neonatal morbidity, mortality and complications  of emergency peripartum  hysterectomy performed at a tertiary teaching hospital in South India and to compare the results with other reports in literature.Methods: During the period of study between January 2015-December 2016, there were 50 cases of emergency peripartum hysterectomy at Tirunelveli medical college hospital, Tirunelveli, Tamil Nadu, South India. Medical, pathology and operation theatre records were analyzed retrospectively. Details of maternal age, parity, booking status, underlying risk factors, past obstetric history, gestational age at delivery ,mode of delivery ,indications for emergency peripartum hysterectomy, type of operation, intraoperative and post-operative complications, blood components transfusion ,maternal and neonatal  outcomes were noted and analyzed.Results: During the 2-year study period there were 50 emergency peripartum hysterectomy out of 14,363 deliveries, a rate of 1 per 294 deliveries (3.4/1000 deliveries). 80% of hysterectomies were performed after caesarean delivery and 20%  after vaginal delivery. The two major indications were abnormal placentation (40%) and uterine atony (28%). There were 6 maternal deaths among patients who underwent emergency peripartum hysterectomy during the period of study.Conclusions: Improved antenatal care, correction of anaemia, identification of risk factors for peripartum hysterectomy, timely referral, expedite management, timely decision, availability and liberal use of blood components and appropriate management of post-operative complications by experienced clinical team are the main stay for saving maternal lives. With increasing rate of caesarean section there is rise in the incidence of abnormal placentation.


Author(s):  
Harpreet Kaur ◽  
Balpreet Kaur ◽  
Sarvjeet Kaur

Background: Emergency peripartum hysterectomy refers to the abdominal hysterectomy performed during or immediately after cesarean section or vaginal delivery, in a setting of life threatening haemorrhage. Over the past two decades, incidence of cesarean section has greatly increased which emerges as one of the cause for abnormal placentation in subsequent pregnancies thus resulting in increased incidence of haemorrhage. The unplanned nature of the surgery and acute blood loss renders the patient in a less than ideal situation to undergo such a dramatic surgery. Evaluation of risk factors, adequate resuscitation, involvement of senior obstetrician and timely decision for EPH in cases of refractory peripartum haemorrhage would help in significantly reducing the maternal mortality and morbidity. Objective was to study the association between cesarean section and emergency peripartum hysterectomy.  Methods: It is a retrospective study of all women who had undergone emergency peripartum hysterectomy between January 2015 to January 2018 in the Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College, Faridkot. Incidence, indications, risk factors and complications of emergency peripartum hysterectomies (EPH) were recorded.Results: During three years period the overall incidence of EPH was 1.85 per 1000 deliveries.Conclusions: Emergency peripartum hysterectomy is a challenging procedure performed in obstetrics when all other conservative methods to control uterine haemorrhage have failed. With increased incidence of cesarean sections the cause of emergency peripartum hysterectomy has greatly shifted from uterine atony to abnormal placentation.  Abnormal placentation has now become the most commonly associated indication for EPH. Recognising and assessing patients at risk with appropriate and timely intervention would help in ensuring a better outcome in this otherwise difficult situation.


1993 ◽  
Vol 168 (3) ◽  
pp. 879-883 ◽  
Author(s):  
Lorraine M. Stanco ◽  
David B. Schrimmer ◽  
Richard H. Paul ◽  
Daniel R. Mishell, Jr.

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Eyob Alemayehu Gebreyohannes ◽  
Daniela Fialova

<b><i>Background and Aim:</i></b> Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia. <b><i>Methods:</i></b> We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI). <b><i>Results:</i></b> We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16–2.51) was significantly associated with PIM use. <b><i>Conclusion:</i></b> This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.


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