scholarly journals Emergency peripartum hysterectomy in a tertiary teaching hospital in Northern Jordan: a 15-year review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Hasan Rawashdeh ◽  
Rawan Obeidat ◽  
Lubna Masaadeh
Keyword(s):  
Cesarean Section ◽  
Statistical Significance ◽  
University Hospital ◽  
Peripartum Hysterectomy ◽  
Adherent Placenta ◽  
Subtotal Hysterectomy ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Emergency Peripartum Hysterectomy

AbstractEmergency peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum hemorrhage. It is associated with a high rate of maternal morbidity among survivors. This work aims to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over 15 years. A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormally adherent placenta were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The chi-square test, Fisher’s exact, and independent sample T test were used for analysis. Statistical significance was declared at α < 0.05. The incidence of peripartum hysterectomy was 1.38 per 1000 births. Fifty-nine were performed after cesarean section and three were performed after vaginal delivery (P<0.001). Abnormally adherent placenta (accreta, increta, and percreta) was the main indication (44.06%). The strongest risk factor for abnormally adherent placenta was placenta previa with previous cesarean section (P=0.001, OR 16.25, 95% CI 1.95-135.01). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (27.11%). No difference in morbidity was noted between total and subtotal hysterectomy. The incidence of emergency peripartum hysterectomy is increasing steadily over the last two decades in the north of Jordan. Abnormally adherent placenta is the most common indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications’ development, admission to the intensive care unit, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant.

scholarly journals Emergency peripartum hysterectomy in a tertiary teaching hospital in Northern Jordan: a 15-year review

2020 ◽  
Author(s):  
Hasan Rawashdeh ◽  
Rawan Obeidat ◽  
Lubna Masaadeh
Keyword(s):  
Caesarean Section ◽  
Statistical Significance ◽  
University Hospital ◽  
Abnormal Placentation ◽  
Peripartum Hysterectomy ◽  
Subtotal Hysterectomy ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Emergency Peripartum Hysterectomy

Abstract Background Emergency Peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum haemorrhage. It is associated with a high rate of maternal morbidity among survivors. The aim of this work is to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over a 15-year period. Methods A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormal placentation were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The Chi-square test, Fisher’s exact and Independent Sample T-Test were used for analysis. Statistical significance was declared at α < 0.05. Results The incidence of peripartum hysterectomy was 1.46 per 1000 births. Sixty-three were performed after caesarean section and three were performed after vaginal delivery (P < 0.001). Abnormal placentation (accreta, increta and percreta) was the main indication (46.03%). The strongest risk factor for abnormal placentation was placenta previa with previous caesarean section (P < 0.001, OR 17.33, 95% CI 2.09–143.14). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (26.98%). No difference in morbidity noted between total and subtotal hysterectomy. Conclusions The incidence of emergency peripartum hysterectomy in increasing steadily over the last two decades in the north of Jordan. Abnormal placentation is the commonest indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications` development, admission to the ICU, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant.

scholarly journals Peripartum hysterectomy and its risk factors

2019 ◽  
Vol 9 (1) ◽  
pp. 27-31
Author(s):  
Renuka Tamrakar ◽  
Upendra Pandit ◽  
Sabita Shrestha ◽  
Basant Sharma ◽  
Rakshya Joshi
Keyword(s):  
Placenta Accreta ◽  
Length Of Hospital Stay ◽  
Cross Sectional Study ◽  
Morbidity Rate ◽  
Sectional Study ◽  
Cross Sectional ◽  
Peripartum Hysterectomy ◽  
Estimated Blood Loss ◽  
Severe Hemorrhage ◽  
Emergency Peripartum Hysterectomy

Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy. Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts. Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded. Conclusions: The timely intervention improves the outcome in Peripar­tum Hysterectomy, which is frequently associated with abnormal placen­tation as a consequence of increasing caesarean deliveries rate.

P0080INTERLEUKIN-17A GENE POLYMORPHISM (RS2275913G>A) IN SLE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nehal Atef elshabrawy ◽  
Hussein Sheashaa ◽  
Adel L Abdelsalam ◽  
Ahmed Mohammed Abd El Wahab
Keyword(s):  
Lupus Nephritis ◽  
Gene Polymorphism ◽  
Inflammatory Diseases ◽  
Statistical Significance ◽  
Group Versus ◽  
University Hospital ◽  
Control Group ◽  
Cross Sectional ◽  
Dsdna Antibody ◽  
Significant Difference

Abstract Background and Aims There are six IL-17-family ligands [IL-17A, IL-17B, IL-17C, IL-17D, IL-17E (IL-25) and IL-17F]. Interleukin-17A (IL-17A) also commonly called IL-17, is produced by the T helper17 (Th17) subset of CD4+ T cells.Interleukin-17 and other Th17 cytokines are linked to the pathogenesis of diverse autoimmune and inflammatory diseases. IL-17A is detected in synovial fluids and synovium from RA patients and induces proinflammatory cytokine production from synoviocytes, also expression of IL-17A was higher in SLE patients and its level positively correlated with the severity of lupus nephritis, because of its contribution to increasing anti-double-stranded DNA (dsDNA) antibody production in SLE. The aim of the present study is to determine the IL-17A gene polymorphism (rs2275913 G&gt;A) frequency in patients with SLE and lupus nephritis, and to determine the association of this polymorphism with the disease activity. Method This cross-sectional, observational, case control study was carried out on 50 females patients, with their age ranged from 15 to 50 years (mean 25.67±9.29 years) with SLE attending Mansoura University Hospital .A control group of 50 healthy females of matched age were also included. The patient group was subdivided into patients with and those without lupus Nephritis (35 and 15 patients, respectively). Lupus nephritis was confirmed by renal biopsy. All patients were subjected to a thorough clinical evaluation and routine laboratory tests. SLEDAI score was calculated for all patients to determine the degree of lupus activity. DNA extraction was performed for all patients as well as controls, One SNPs of IL-17A (rs2275913G&gt;A) was genotyped utilizing PCR- RFLP technique. Results The frequency of rs2275913 A allele was significantly higher in SLE patients than the control group (34.0% vs. 21.0%, respectively; p=0.04, OR =1.9, 95%CI =1.03-3.65). While G allele was significantly higher in control group, (P=0.04)). Moreover, AA genotype was significantly higher in the SLE patients than in the control group (8.0% vs. 0.0%, respectively; p=0.036) and associated with higher SLEDAI, ANA, and anti-dsDNA antibodies titer, (P=0.03, P=.039, P=0.047 respectively).on the other hand there was no significant difference in GG and GA genotypes in the SLE patients versus the control group. The frequency of both genotype GA and AA was higher in the SLE patients than the controls (60% vs. 42%, respectivley; OR=2.07, CI-95%=0.9-5.59); although the difference was not statistically significant (P= 0.07).Although A allele was numerically higher in lupus nephritis group versus non nephritis group(37.0% vs 27.0%, respectively), the Analysis of the frequency of IL-17A rs2275913 alleles and genotypes showed no statistical differences between the two groups. Moreover there was no statistical significance between different genotypes in cases of nephritis regard lupus nephritis class (P=0.9) and no statistical significance between different genotypes (GG-GA-AA) regarding activity indices (AI) or chronicity indices (CI) in lupus nephritis group (P=0.18, P=0.56 respectively). Conclusion We suggest that there was a significant association between IL-17A rs2275913 G&gt;A polymorphism and SLE, as A allele and AA genotype were increased in SLE patients, lupus nephritis especially those with high activity

Efficacy of Yttrium-90 Zevalin Outside of Clinical Trials: Preliminary Results of a Retrospective Bi-Center Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5015-5015
Author(s):  
Francesco Cicone ◽  
Francesco Scopinaro ◽  
Sebastien Baechler ◽  
Nicolas Ketterer ◽  
Franz Buchegger ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Setting ◽  
Patient Population ◽  
Statistical Significance ◽  
University Hospital ◽  
Low Grade ◽  
Number Of Patients ◽  
Significant Difference ◽  
Routine Clinical Setting

Abstract Background and Aim: Due to limited data regarding the efficacy of Radioimmunotherapy with 90Y-Zevalin (RIT-Z) outside of controlled clinical trials, we carried out a biinstitutional, international retrospective study to assess the efficacy of RIT-Z in a routine clinical setting. The relationship between the number of previous therapies and outcomes as well as the response to the last therapy was assessed. Possible differences in outcomes for patients treated in the two different centers were also analyzed. Materials and Methods: Forty-three consecutive patients treated at the University Hospital of Lausanne (CHUV, Switzerland) and at S. Andrea University Hospital of Rome (Italy) were evaluated, none of which had been previously included in clinical trials. Only 31 patients entered the final analysis: patients lost at follow up, undergoing autologous transplantation (ASCT), or treated within the last 3 months were excluded. Efficacy of therapy was evaluated in terms of Overall Survival (OS), Progression Free Survival (PFS), and Time to Next Treatment (TTNT). Survival curves were obtained with the Kaplan- Meier method (statistical significance = p&lt;0.05). Results: Characteristics of the patient population are listed in Table 1. Although 50% of the patients had aggressive histologies, patients treated at S. Andrea had slightly more favorable features than those treated at CHUV. Fourteen patients (45%) had received at least 4 previous treatments, and all had received Rituximab. Fourteen patients (45%) had not responded to the last therapy, while 6 (19%), all treated at S.Andrea, were considered disease-free at the time of RIT-Z, which was administered for consolidation. Median follow up time was 20 months (11.5 vs. 25 months for S.Andrea and CHUV, respectively). Median PFS and TTNT were similar. After achieving a partial response, 2 patients were referred to Rituximab maintenance after RIT-Z and remain progression-free. Median OS was still not attained. Although not statistically significant, a trend towards better outcomes for S. Andrea patients was found. In comparing patients with indolent and aggressive lymphoma, only PFS was found to be significantly different (median PFS: 10 vs. 5 months, p&lt;0.05). In patients with &lt;4 and ≥ 4 previous therapies, twenty month OS was 88% vs. 53.6% (p=0.02), respectively; median TTNT was 22 vs. 5 months (p=0.013), while differences in PFS did not attain statistical significance. The duration of response in non-responders to their last therapy was shorter than in responders: 20-month OS- 44% vs. 94% (p=0.0015), median PFS and TTNT- 3.5 vs. 15 months (p=0.0002) and 4 vs. 15 months (p=0.0001), respectively. Median PFS and TTNT after RIT-Z did not differ from those found after the last therapy. A significant difference in outcomes for heavily pretreated or refractory patients was found in those with low grade follicular lymphoma. Conclusions: Poorer outcomes were found in our patient population treated in a routine clinical setting compared to those enrolled in clinical trials. This may be related to greater heterogeneity of our study cohort which included more patients with unfavorable conditions (e.g. aggressive NHL, ≥4 treatment courses including rituximab in all, and ASCT in 25%). Our results suggest that the best benefit may be expected with RIT-Z either for consolidation or relatively earlier in the course of NHL treatment. Table 1. Total CHUV S. Andrea Population Analyzed (72%) Number of patients 43 23 20 31 Median Age 61 63 58,5 62 Aggressive Histology (FL grade 3 or DLBCL) 18 (41,8%) 8 (34,7%) 10 (50%) 11 (35,5%) Indolent Histology (FL grade 1 or 2) (%) 25 (58,2%) 15 (65,3%) 10 (50%) 20 (64,5%) Patients with ≥4 previous treatments 19 (44,2%) 12 (52,1%) 7 (35%) 14 (45,2%) Patients with previous ASCT 11 (25,6%) 6 (26%) 5 (25%) 8 (25%)

scholarly journals Emergency peripartum hysterectomy: a retrospective analysis in a tertiary care hospital in Jharkhand, India

2018 ◽  
Vol 7 (8) ◽  
pp. 3179
Author(s):  
Megha Bhagat ◽  
Bratati Moitra
Keyword(s):  
Retrospective Analysis ◽  
Uterine Rupture ◽  
Tertiary Care ◽  
Bladder Injury ◽  
Care Hospital ◽  
Peripartum Hysterectomy ◽  
Morbidly Adherent Placenta ◽  
Cesarean Deliveries ◽  
Adherent Placenta ◽  
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.

scholarly journals Effect of Glucose-Insulin-Potassium Infusion on Hemodynamics in Patients with Septic Shock

2021 ◽  
Vol 9 (B) ◽  
pp. 1517-1524
Author(s):  
Hassan Effat ◽  
Ramy Khaled ◽  
Ahmed Battah ◽  
Mohamed Shehata ◽  
Waleed Farouk
Keyword(s):  
Septic Shock ◽  
Myocardial Dysfunction ◽  
Statistical Significance ◽  
Lactate Clearance ◽  
University Hospital ◽  
Control Group ◽  
Surviving Sepsis Campaign ◽  
Significant Difference ◽  
Successful Weaning ◽  
Infusion Protocol

BACKGROUND: Glucose-insulin-potassium (GIK) demonstrates a cardioprotective effect by providing metabolic support and anti-inflammatory action, and may be useful in septic myocardial depression. AIM: The aim of this study was to assess role of GIK infusion in improving hemodynamics in patients with septic shock in addition to its role in myocardial protection and preventing occurrence of sepsis-induced myocardial dysfunction and sepsis-induced arrhythmias. METHODS: This study was conducted on 75 patients admitted to the Critical Care Department in Cairo University Hospital with the diagnosis of septic shock during the period from January 2019 to December 2019. Patients were divided into two groups; first group was managed according to the last guidelines of surviving sepsis campaign and was subjected to the GIK infusion protocol while second group was managed following the last guidelines of surviving sepsis campaign only without adding GIK infusion. RESULTS: Patients in the GIK group showed better lactate clearance (50% vs. 46.7%) and less time needed for successful weaning of vasopressors than the control group (3.57±1.16 vs. 3.6±1.45 days) thought not reaching statistical significance. There was no statistically significant difference between both groups regarding development of septic-induced cardiomyopathy (16.7% in the control group vs. 13.3% in the GIK group); however, patients with hypodynamic septic shock showed better improvement in hemodynamic profile in the GIK group. Sepsis-induced arrhythmias occurred more in patients of the control group than in patients of the GIK group with no statistically significant difference between both groups (33.3% vs. 20%, p = 0.243). Few side effects were developed as a result of using GIK infusion protocol. CONCLUSIONS: GIK may help in improving hemodynamics and weaning of vasopressors in patients with refractory septic shock and those with septic induced cardiomyopathy. The use of GIK was well tolerated with minimal adverse reactions.

scholarly journals Bilateral internal thoracic artery grafting in haemodialysis patients with diabetic nephropathy

2020 ◽  
Vol 31 (6) ◽  
pp. 774-780
Author(s):  
Kohei Hachiro ◽  
Takeshi Kinoshita ◽  
Tomoaki Suzuki ◽  
Tohru Asai
Keyword(s):  
Diabetic Nephropathy ◽  
Internal Thoracic Artery ◽  
Cox Regression ◽  
Statistical Significance ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
University Hospital ◽  
Deep Sternal Wound Infection ◽  
Significant Difference

Abstract OBJECTIVES To compare postoperative outcomes in patients with diabetic nephropathy receiving haemodialysis and undergoing isolated coronary artery bypass grafting (CABG) using bilateral or single skeletonized internal thoracic artery (ITA). METHODS Among 1441 consecutive patients undergoing isolated CABG between 2002 and 2019 at our university hospital, we retrospectively analysed data for 107 patients with diabetic nephropathy receiving haemodialysis. After inverse probability of treatment weighting, we found no statistically significant differences regarding patients’ preoperative characteristics. RESULTS All patients underwent myocardial revascularization using the off-pump technique. There was no statistical significance in postoperative deep sternal wound infection (P = 0.902) and 30-day mortality (P = 0.755). However, the bilateral ITA group had a lower rate of postoperative stroke versus the single group (0% vs 5.5%, respectively; P = 0.021). Follow-up was completed in 95.3% (102/107) of the patients, and the mean follow-up duration was 3.3 years. Thirty-eight deaths occurred in the bilateral ITA group and 18 in the single ITA group. There was no significant difference in all-cause death (P = 0.558) and cardiac death rates (P = 0.727). Multivariable Cox regression models showed that the independent predictors of all-cause death were age [hazard ratio (HR) 1.031; P = 0.010], previous percutaneous intervention (HR 1.757; P = 0.009) and gastroepiploic artery grafting (HR 0.582; P = 0.026). CONCLUSIONS Bilateral ITA grafting in patients with diabetic nephropathy receiving haemodialysis did not improve mid-term outcomes.

Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review

2015 ◽  
Vol 292 (6) ◽  
pp. 1201-1215 ◽  
Author(s):  
Cara Z. de la Cruz ◽  
Erika L. Thompson ◽  
Kathleen O’Rourke ◽  
Wendy N. Nembhard
Keyword(s):  
Systematic Review ◽  
Cesarean Section ◽  
High Income ◽  
Peripartum Hysterectomy ◽  
Emergency Peripartum Hysterectomy

scholarly journals Comparison between different methods of breast implant volume choice and degree of postoperative satisfaction

2018 ◽  
Vol 45 (1) ◽  
Author(s):  
RAFAEL DAIBERT DE SOUZA MOTTA ◽  
ANA CLAUDIA WECK ROXO ◽  
FABIO XERFAN NAHAS ◽  
FERNANDO SERRA-GUIMARÃES
Keyword(s):  
Postoperative Period ◽  
Breast Augmentation ◽  
Rio De Janeiro ◽  
Statistical Significance ◽  
Breast Implant ◽  
Augmentation Mammaplasty ◽  
University Hospital ◽  
Surgical Scar ◽  
Significant Difference ◽  
Degree Of Satisfaction

ABSTRACT Objectives: to assess the degree of patient satisfaction after undergoing breast augmentation and compare three different, easy, inexpensive and universal methods of preoperative choice of breast implant volume. Methods: a prospective study was carried out at University Hospital Pedro Ernesto of State University of Rio de Janeiro, in 94 women from Rio de Janeiro, aged 18 to 49 years, submitted to breast augmentation mammaplasty with breast implant due to hypomastia. All implants were textured, with a round base and high projection and were introduced into the retroglandular space through an inframammary access. The patients were divided into three groups: Control, Silicone and MamaSize®, with 44, 25 and 25 patients, respectively. Satisfaction questionnaires were applied in the pre and postoperative periods by the same evaluator, through the visual analogue scale, in which ‘0’ meant very unsatisfied and ‘100’ very satisfied for the four variables: shape, size, symmetry and consistency. The degree of satisfaction with the surgical scar was also assessed in the postoperative period. Results: when the preoperative and postoperative satisfaction levels were compared, there was a difference in all variables for the three groups, with statistical significance. However, when the postoperative data were compared with each other, there was no significant difference. The degree of satisfaction with the surgical scar was high. Conclusion: the augmentation mammaplasty with breast implant had a high index of satisfaction among patients. However, there was no difference in the degree of satisfaction in the postoperative period between the three methodologies of breast volume measurement.

scholarly journals Peripartum hysterectomy at a tertiary center

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Monica Gurung ◽  
Gehanath Baral
Keyword(s):  
Cesarean Section ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Bladder Injury ◽  
Abnormal Placentation ◽  
Peripartum Hysterectomy ◽  
Tertiary Center ◽  
Emergency Peripartum Hysterectomy ◽  
Ruptured Uterus

Aims: To find out the incidence, indications, complication of emergency peripartum hysterectomy in a tertiary care center. Methods: This was a retrospective study conducted over a period of 18 months from April 2017 to October 2018 at Paropakar Maternity and Women’s Hospital in Kathmandu. Data were obtained from the operation theater register and record section. Results: Out of 30917 deliveries in 18 months 18 had lifesaving emergency peripartum hysterectomy (0.58 per 1000 deliveries). The most common indication being morbidly adherent placenta/placenta previa (8; 44%) followed by ruptured uterus (5; 28%), uterine atony (4; 22%). The most common risk factor is attributed to previous cesarean section (11; 61%) followed by abnormal placentation (7; 39%). Most common morbidity was febrile morbidity followed by wound infection and bladder injury. Conclusion: Abnormal placentation and past cesarean section contributed to be the major indication of peripartum hysterectomy.

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