Neonatal Outcomes After the Obstetric Near-miss Events Uterine Rupture, Abnormally Invasive Placenta and Emergency Peripartum Hysterectomy

Background: Emergency peripartum hysterectomy (EPH) is a rare but a lifesaving procedure done as a last resort to save life of mother. We conducted this study to know the incidence, leading causes, and complications of obstetric hysterectomy.Methods: Authors conducted a retrospective analysis of all the patients who underwent emergency peripartum hysterectomy from January 2015 to December 2017 at RIMS, Ranchi.Results: There were 126 emergency peripartum hysterectomies, with deliveries during the same period being 21732 and the rate of EPH was 5.7 per 1000 deliveries. Most common indication for EPH was uterine rupture (54.6%), followed by uterine atony (18.2%) and morbidly adherent placenta (23.01%). Most of the patients (66.67%) had previous cesarean deliveries. EPH was done following cesarean in 66.67%. Subtotal hysterectomy was done in 88.09%. Intra-operative urinary bladder injury was seen in 11.11% of the patients.Conclusions: Uterine rupture and Morbidly adherent placenta continues to be the most common causes for EPH in our population. Multiparity is an important risk factor among patients with rupture uterus. Cesarean delivery and repeat cesarean deliveries are the likely risk factors for EPH.

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Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More?

Obstetrics and Gynecology International ◽

10.1155/2016/5349063 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Hironori Takahashi ◽

Akihide Ohkuchi ◽

Rie Usui ◽

Hirotada Suzuki ◽

Yosuke Baba ◽

...

Keyword(s):

Blood Loss ◽

Balloon Catheter ◽

Massive Bleeding ◽

Peripartum Hysterectomy ◽

Perinatal Center ◽

Invasive Placenta ◽

Primiparous Women ◽

Emergent Surgery ◽

Abnormally Invasive Placenta ◽

Prior Cesarean Section

Introduction. To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy).Methods. We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center. We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique.Results. AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919). Of the 18, 14 (78%) had a prior cesarean section (CS) history and the other 4 (22%) were primiparous women. Planned AIP-hysterectomy was performed in 12/18 (67%), with the remaining 6 (33%) undergoing emergent AIP-hysterectomy. Of the 6, 4 (4/6: 67%) patients were primiparous women. An intra-arterial balloon was inserted in 9/18 (50%). Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon (4,448±1,948versus8,861±3,988 mL), planned hysterectomy (5,003±2,057versus9,957±4,485 mL), and prior CS (5,706±2,727versus9,975±5,532 mL). Patients with prior CS (−) bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation.Conclusion. Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy. Massive bleeding occurred in emergent AIP-hysterectomy without prior CS.

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Emergency Peripartum Hysterectomy In Mendefera Hospital-Case Control Study

10.21203/rs.3.rs-620623/v1 ◽

2021 ◽

Author(s):

Dawit Sereke ◽

Habte Hailemelcot ◽

Ogbaselassie Gebremeskel ◽

Zeccarais Andemaraim

Keyword(s):

Uterine Rupture ◽

Case Control Study ◽

Case Fatality ◽

Fetal Outcome ◽

Case Control ◽

Uterine Atony ◽

Surgical Removal ◽

Peripartum Hysterectomy ◽

Emergency Peripartum Hysterectomy ◽

Control Study

Abstract Background Emergency peripartum hysterectomy is a life-saving procedure which involves the surgical removal of uterus and is usually performed for uncontrollable maternal haemorrhage when all other conservative management has failed. The aim of this study was to determine the incidence, indication, risk factors and perinatal/maternal outcome related to EPH performed in Mendefera Regional Referral Hospital Methods Case-control study was carried out in women, who underwent EPH over a period of almost 8 years. Controls were women, who had spontaneous vaginal delivery or were delivered by Caesarean section, without EPH. The findings were analyzed using Stata 14. Results During the study period, there were a total of 15,527 deliveries and 31 cases of emergency peripartum hysterectomies, giving an incidence of 2 per1000 deliveries. The mean age, parity, and hospital stay of the cases was 31.5, 4.0 and 5.5 respectively. The main indications for the procedure were uterine atony (38.7%) and uterine rupture (25.8%). Factors showing a significant association with EPH were: being 40 + years of age (OR 10.6; 95%CI 1.5–76.1), being grand multiparous (OR 8.0; 95%CI 2.1–30.4) and CS on the index pregnancy (OR 16.6; 95%CI 7.80-35.95). Subtotal hysterectomy was performed in majority (74%) of cases. The case fatality rate and stillbirth rate was 13% and 34.4% respectively. Conclusion The incidence of EPH in our institution is very high and fetal outcome was poor. The commonest indication for EPH was severe hemorrhages most notably caused by uterine atony or uterine rupture, which are largely preventable.

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Emergency Peripartum Hysterectomy: A Life Saving Procedure in Obstetrics

Faridpur Medical College Journal ◽

10.3329/fmcj.v13i1.38011 ◽

2018 ◽

Vol 13 (1) ◽

pp. 12-16

Author(s):

Dilruba Zeba ◽

Tonmoy Biswas ◽

Shila Rani Das ◽

Biswanath Roy ◽

Md Abul Khair

Keyword(s):

Caesarean Section ◽

Uterine Rupture ◽

Relevant Literature ◽

Total Abdominal Hysterectomy ◽

Placenta Praevia ◽

Normal Vaginal Delivery ◽

Bladder Injury ◽

Peripartum Hysterectomy ◽

Life Saving ◽

Emergency Peripartum Hysterectomy

Emergency peripartum hysterectomy refers to the uterine removal after a caesarean section or normal vaginal delivery for any life saving purpose, immediately after delivery or within the puerperium. In general, abnormal placentation, uterine rupture, and postpartum haemorrhage are the common indications. The prime objective of this study was to determine the frequent indications, peroperative and postoperative complications, maternal and perinatal outcome. This retrospective descriptive study was conducted by analysing recorded data of one year between July 2016 and June 2017 in Faridpur district of Bangladesh. Total 40 cases were analysed. Placenta praevia was the most common indication, whereas uterine rupture was the second one. Urinary bladder injury was the frequent peroperative complication. This bladder injury was common in cases of previous repeated caesarean section associated with placenta praevia. All the patients required three to six unit blood transfusions on average. Four patients expired due to various causes. Most of the patients were elderly aged, multiparous and had previous caesarean sections. The relevant literature analysis was done for comparison, where similarities were found. Total abdominal hysterectomy was the preferred method in this study. Overall, the study will direct the future ways of management.Faridpur Med. Coll. J. Jan 2018;13(1): 12-16

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Obstetric complications of placenta previa percreta

Vojnosanitetski pregled ◽

10.2298/vsp1412163s ◽

2014 ◽

Vol 71 (12) ◽

pp. 1163-1166 ◽

Cited By ~ 4

Author(s):

Radmila Sparic ◽

Ljiljana Mirkovic ◽

Uros Ravilic ◽

Tijana Janjic

Keyword(s):

Uterine Rupture ◽

Maternal Morbidity ◽

Vaginal Bleeding ◽

Placenta Previa ◽

Bladder Wall ◽

Fistula Formation ◽

Ureteral Stricture ◽

Uterine Incision ◽

Invasive Placenta ◽

Abnormally Invasive Placenta

Introduction. Placenta previa is related to severe maternal and fetal morbidity. The increasing incidence of cesarean delivery rate causes a marked increase in abnormally invasive placenta over the past decades. The abnormally invasive placenta is becoming the foremost cause of obstetric hemorrhage and postpartum hysterectomy, causing a significant maternal and fetal morbidity and even mortality. Maternal morbidity in such cases also comprise politransfusion, development of disseminated intravascular coagulation, uterine rupture, cystostomy, fistula formation, ureteral stricture, intensive care unit admission, infection, and prolonged hospitalization, adult respiratory distress syndrome, renal failure, septicemia and even death. Case report. A 38-year-old gravida 3, para 2, was admitted to our hospital at 27 weeks of gestation as an emergency due to vaginal bleeding, previously diagnosed with an anterior placenta previa. Following tocolytic therapy, bleeding stopped. The patient was informed on the diagnosis and the possibility of lifethreatening hemorrhage necessitating preterm delivery. She was given corticosteroids to enhance fetal lung maturity. At 28 weeks of gestation, she experienced massive vaginal bleeding, and a decision was made to perform emergency cesarean section. We made a corporeal transverse uterine incision well above the uterovesical fold and tortuous vessels, at the same time avoiding the superior edge of the placenta. The placenta was found to be densely adherent to the lower uterine segment, penetrating through it and infiltrating the posterior wall of the urinary bladder. An attempt to remove the placenta resulted in injury to the bladder wall and the uterine rupture at a previous cesarean scar. The decision was made to perform total abdominal hysterectomy with placenta left in situ. At present, both mother and the baby are well. Conclusion. Anticipation and the surgeon's judgment are leading factors for surgery, from the choice of uterine incision type to the decision to proceeding to hysterectomy in order to reduce maternal morbidity.

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Maternal and Neonatal Outcomes Following Abnormally Invasive Placenta

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000542339.51514.c8 ◽

2018 ◽

Vol 38 (3) ◽

pp. 123-124

Author(s):

H.J. Baldwin ◽

J.A. Patterson ◽

T.A. Nippita ◽

S. Torvaldsen ◽

I. Ibiebele ◽

...

Keyword(s):

Neonatal Outcomes ◽

Invasive Placenta ◽

Maternal And Neonatal Outcomes ◽

Abnormally Invasive Placenta

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Obstetric Hysterectomy and Maternal Survival

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v9i2.11759 ◽

2014 ◽

Vol 9 (2) ◽

pp. 33-37

Author(s):

J Baral ◽

G Gurung ◽

A Rana ◽

B Manandhar ◽

R Manandhar ◽

...

Keyword(s):

Cesarean Section ◽

Placenta Accreta ◽

Single Case ◽

Near Miss ◽

University Teaching ◽

Placenta Increta ◽

Peripartum Hysterectomy ◽

Maternal Survival ◽

Vaginal Deliveries ◽

Emergency Peripartum Hysterectomy

Aims: This study was done to analyze the cases of obstetric hysterectomy and maternal complications and survival after that. Methods: A retrospective study was carried out from the review of records of the near miss, maternal mortality, cesarean audit and operation theater record of the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH), Kathmandu from 2057-2071 BS. Results: Fourteen maternal survival resulted following total of 19 obstetric hysterectomy, subtotal hysterectomy being the procedure of choice in 11 cases, emergency peripartum hysterectomy (EPH) being performed in abundance (18/19) in comparison to an elective peripartum hysterectomy, which was undertaken in a single case of placenta percreta, and inclusive of latter were four cases of morbid placental adhesion, a placenta increta and two placenta accreta. Eight out of 19 cases had vaginal delivery and rest had cesarean section. Among seven cases of cesarean hysterectomy 3 were done for placenta previa with accreta one case each done for abruptio placentae and placenta accreta and two cases were done for extra placental causes. Among four cases of emergency peripartum hysterectomy (EPH), which were relaparotomy followed by hysterectomy, three cases were done for complication of cesarean section and one done for uterine atonicity. Four cases of spontaneous vaginal deliveries needed peripartum hysterectomy two of them were complicated by morbid placental adhesion placenta increta (1), placental percreta (1), two cases were vaginal birth after cesarean (VBAC). Seven cases of uterine rupture had undergone peripartum hysterectomy. Conclusions: Obstetric hysterectomy is a lifesaving surgical procedure for maternal survival whenever necessary and mandates a quick decision making process, however in consideration of younger age and low parity or nulliparity, the best obstetric governance and services must foresee not to let mothers meet such situation necessitating organ removal and to enjoy potential reproductive life cycle.DOI: http://dx.doi.org/10.3126/njog.v9i2.11759

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