scholarly journals Emergency peripartum hysterectomy and its association with cesarean section: a 3 years retrospective study

2018 ◽  
Vol 7 (5) ◽  
pp. 1844
Author(s):  
Harpreet Kaur ◽  
Balpreet Kaur ◽  
Sarvjeet Kaur
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Cesarean Section ◽  
Abdominal Hysterectomy ◽  
Abnormal Placentation ◽  
Difficult Situation ◽  
Mortality And Morbidity ◽  
Peripartum Hysterectomy ◽  
Patients At Risk ◽  
Emergency Peripartum Hysterectomy

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.

scholarly journals Emergency peripartum hysterectomy: a 7-year review at tertiary hospital

2019 ◽  
Vol 8 (9) ◽  
pp. 3812
Author(s):  
Manjula S. K. ◽  
Suvarchala Katakam ◽  
Shobha G.
Keyword(s):  
Risk Factors ◽  
Tertiary Hospital ◽  
Bladder Injury ◽  
Abnormal Placentation ◽  
Peripartum Hysterectomy ◽  
Life Saving ◽  
Peripartum Hemorrhage ◽  
Emergency Peripartum Hysterectomy ◽  
Saving Measure ◽  
Record Review

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.

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.

scholarly journals Emergency peripartum hysterectomy at a tertiary care hospital: analysis of epidemiology, clinical profile, indications and outcome

2019 ◽  
Vol 8 (4) ◽  
pp. 1308
Author(s):  
Anitha E. ◽  
Ramalakshmi S.
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
South India ◽  
Blood Components ◽  
Abnormal Placentation ◽  
Peripartum Hysterectomy ◽  
Operative Complications ◽  
Emergency Peripartum Hysterectomy ◽  
Post Operative Complications

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.

scholarly journals Incidence and Complications of Emergency Peripartum Hysterectomy: A Retrospective Study at Maternal and Child Health Training Institute, Dhaka

2017 ◽  
Vol 13 (1) ◽  
pp. 106-110
Author(s):  
Rowshan Hosne Jahan
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Child Health ◽  
Maternal And Child Health ◽  
Abdominal Hysterectomy ◽  
Peripartum Hysterectomy ◽  
Emergency Peripartum Hysterectomy ◽  
Emergency Hysterectomy ◽  
And Child Health ◽  
Training Institute

Introduction: Emergency peripartum hysterectomy (EPH) is a major surgical venture performed in the setting of life threatening hemorrhage during or immediately after abdominal and vaginal deliveries. In developing countries, 8-10% of maternal mortality directly occurs due to massive obstetrical hemorrhage. Most common indication for emergency peripartum hysterectomy has been uterine atony and uterine rupture. The decision to perform an emergency hysterectomy on a young woman especially one with low parity poses a dilemma for the obstetrician particularly in our society. Objective: To estimate incidence, indications and postoperative complications associated with emergency hysterectomy at Maternal and Child Health Training Institute (MCHTI), Azimpur, Dhaka. Materials and Methods: This is a retrospective study and registration numbers of all women who underwent emergency peripartum hysterectomy were indentified. With the numbers, the case notes were retrieved from the medical records department for in-depth study. Information abstracted included the socio-demographic characteristics of the patients, indications for the hysterectomy, type of hysterectomy performed, booking status of patients, mode of delivery, gestational age at delivery and maternal outcome were recorded in a pre-designed data form. The data were analyzed using simple proportion, rates and tables. Results: There were 18 cases of emergency peripartum hysterectomies performed during the study period of January 2011 to December 2013 (incidence 1.26/1000 deliveries). Commonest age of the middle group was 29-34 years. Ruptured uterus was the commonest indication (9 cases, 50%) and other indications were uterine atony/ PPH (8 cases, 44.44%), placenta praevia (1 case, 5.56%). Subtotal abdominal hysterectomy was done in 17(94.44%) cases whereas total abdominal hysterectomy in 01(5.56%) cases. This emergency procedure was associated with significant number of intraoperative and postoperative complications, However maternal and perinatal outcome was satisfactory. Conclusion: EPH remains an essential life saving procedure and its incidence continues to remain high in our community when compared with developed countries. Effective antenatal care, identification of patients at risk, enhancement of blood transfusion facilities together with improvement of surgical skills are important to reduce the incidence of peripartum hysterectomy as well as morbidity and mortality. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 106-110

scholarly journals Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

2014 ◽  
Vol 52 (193) ◽  
pp. 668-676 ◽  
Author(s):  
Meena Pradhan ◽  
Yong Shao
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Uterine Atony ◽  
Previous Caesarean Section ◽  
Peripartum Hysterectomy ◽  
Incidence Risk ◽  
Emergency Peripartum Hysterectomy

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.

scholarly journals Incidence and Risk Factors of Postpartum Hemorrhage in China: A Multicenter Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Sijian Li ◽  
Jinsong Gao ◽  
Juntao Liu ◽  
Jing Hu ◽  
Xiaoxu Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Cesarean Section ◽  
Subgroup Analysis ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Predictive Performance ◽  
Vaginal Deliveries ◽  
Twin Pregnancies

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women.Methods: A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted.Results: A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813–0.851), 0.824 (95% CI 0.803–0.845), 0.686 (95% CI 0.617–0.755), 0.854 (95% CI 0.834–0.874), and 0.690 (95% CI 0.646–0.735), respectively.Conclusions: The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.

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