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 Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

2021 ◽  
Vol 34 (4) ◽  
pp. 266
Author(s):  
Margarida Cal ◽  
Carla Nunes ◽  
Nuno Clode ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

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

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.

Pattern of Blood Transfusion among Women Undergoing Caesarean Section in a Tertiary Health Care Centre

2021 ◽  
Vol 15 (9) ◽  
pp. 2858-2862
Author(s):  
Umme habiba ◽  
Kalsoom Essa Bhattani ◽  
Zubaida Khanum Wazir ◽  
Samina Sohail ◽  
Hina Ameer Chughtai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Placenta Praevia ◽  
Emergency Cesarean

Background: Cesarean section delivery causes major risk factors in terms of intraoperative performance and blood loss while blood transfusion is a promising factor in emergency care in case of blood unavailability. Women undergoing cesarean section routinely require blood cross-matching. Aim: The present study aimed to evaluate the pattern of blood transfusion among women who underwent c/section at the tertiary care center. Materials and Methods: This cross-sectional study was conducted on 745 pregnant women who underwent cesarean section at Obstetrics & Gynaecology department of Quaid-e-Azam International Hospital Islamabad and PAF hospital Masroor, Karachi for duration of six months from January 2021 to June 2021. The demographic details, incidence of cesarean section, blood transfusion indications and types were recorded. Antenatal intraoperative and pre-operative details were also noted. Complications regarding blood transfusion were analyzed using multivariable analysis and EPI-statistical software v 3.5.3. Results: Of the total 745 cesarean sections, the prevalence of blood transfusion was 10.1%. About 75 women transfused 216 units of blood with packed cells tailed by Fresh Frozen Plasma (FFP). The prevalence of emergency cesarean section was 61 (81.3%) while general anesthesia was utilized in 27 (44.3%) cases. Fetal distress and placenta praevia were the common indications of cesarean section. Placenta praevia Respiratory rate (RR) was 5.01 (p<0.001). Other obstetric complications and risk factors were anemia, antepartum hemorrhage, hypertension, and previous cesarean section. The cross-matched transfusion ratio was 9.93 while the transfusion index and probabilities were 0.078 and 10.1 respectively. Conclusion: Our study found a higher prevalence of blood transfusion risks among pregnant women who underwent cesarean section. It has been observed that the risk of blood transfusion increased with placenta previa, preoperative maternal anemia, placenta abruption, and second stage cesarean section. During the antenatal period, the need for blood transfusion might be reduced with an increased concentration of maternal hemoglobin. Keywords: Blood transfusion, Complications, Caesarean delivery, Transfusion index

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 10-Year Review

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Joana Ferreira Carvalho ◽  
Adelaide Cubal ◽  
Sílvia Torres ◽  
Fernanda Costa ◽  
Olímpia do Carmo
Keyword(s):  
Placenta Previa ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Mortality And Morbidity ◽  
Maternal Characteristics ◽  
Peripartum Hysterectomy ◽  
Tertiary Teaching ◽  
Pregnancy And Delivery ◽  
Severe Hemorrhage ◽  
Emergency Peripartum Hysterectomy

Background. Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Purpose. To determine the incidence, risk factors, indications, outcomes, and complications of EPH performed in a tertiary teaching hospital and to compare the results with other reports in the literature. Methods. The medical records of 13 patients who had undergone EPH, between January 2000 and December 2010, were reviewed retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results. There were 13 EPHs out of 31.767 deliveries, a rate of 0.41 per 1,000 deliveries. Eight hysterectomies were performed after cesarean delivery and five after vaginal delivery. The most common indication for hysterectomy was uterine atony (10/13), followed by placenta previa (2/13). There were one case of intraoperative bladder injury and one case of relaparotomy because of hemoperitoneum. We had one maternal death because of septic shock. There were no cases of neonatal morbidity and mortality. Conclusion. Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face.

Scenario of General Anesthesia for Cesarean Section in Rural Tertiary Care Center in High Altitude Karnali Academy of Health Sciences

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Ramesh Bhattarai ◽  
Rajiv Shah ◽  
Sita Dhakal ◽  
Pragya Malla ◽  
Srijana Sapkota
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
High Altitude ◽  
Spinal Anesthesia ◽  
Neonatal Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Health Sciences ◽  
Tertiary Care Center ◽  
Cord Prolapse

Background: General anesthesia for cesarean section is being less popular for cesarean section in present days but sometime general anesthesia is inevitable. The aim of the study is to assess the trends of general anesthesia, indications, clinical outcome in mother and fetus in high altitude setting of tertiary care center of Nepal. Methods: We conducted descriptive cross-sectional study all cases of cesarean section in Karnali Academy of health Sciences (KAHS) located at high altitude over three years period   in our institute. Data were retrieved from the hospital records during three fiscal year (Jan 1st 2017 to Jan Dec 31st 2019). The record of all the patients who underwent cesarean section under general anesthesia was reviewed for demographic details, indication of general anesthesia, trends for general and spinal anesthesia and maternal and neonatal outcome. Results: Out of total deliveries 2175, 309 (14.2%) cases account for cesarean section. Among them, 52 (17%) required general anesthesia . Eclampsia 19(36%) remain the major indication for General Anesthesia in cesarean section followed by failure of spinal anesthesia number 14 (26%) , cord prolapse six (12%), antepartam haemorrhage five (10%), spinal site infection four (8%), Khiphoscoliosis two(4%), Patients request  two (4%). Use for general anesthesia technique was consistent for three years with slow rise in use of spinal anesthesia . There was no any anesthesia related maternal mortality and nine intraoperative neonatal   Conclusions:  General anesthesia practices are consistently required in rural high-altitude setup. Eclampsia is the commonest indication followed by failure of spinal anesthesia and cord prolapse. Neonatal outcome is still not good.  

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

Sign in / Sign up

Export Citation Format

Share Document