scholarly journals Emergency Peripartum Hysterectomy: A Life Saving Procedure in Obstetrics

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

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 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 A study on peripartum hysterectomy in a tertiary referral government hospital

2019 ◽  
Vol 8 (12) ◽  
pp. 4971
Author(s):  
Chaithra M. ◽  
Tejeswini K. K. ◽  
Savitha C.
Keyword(s):  
Caesarean Section ◽  
Postpartum Haemorrhage ◽  
Mode Of Delivery ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Peripartum Hysterectomy ◽  
Obstetrics And Gynaecology ◽  
Vaginal Deliveries ◽  
Life Threatening ◽  
Emergency Peripartum Hysterectomy

Background: Emergency peripartum hysterectomy (EPH) is a major surgical venture invariably performed in the setting of life-threatening haemorrhage during or immediately after abdominal and vaginal deliveries. Aim of the study was to study the frequency and indications for peripartum hysterectomy and to assess the maternal outcome of peripartum hysterectomy.Methods: Cross sectional study was done in the department of obstetrics and gynaecology, Vanivilas hospital, Bangalore from September 2018 to august 2019. This study consists of 24 cases of emergency peripartum hysterectomy within 24 hours of delivery, operated at Vanivilas hospital.Results: The frequency of peripartum hysterectomy was 1.102/1000 deliveries and following caesarean section and vaginal deliveries are 3.544/1000 deliveries and 0.248/1000 deliveries respectively. Among 24 cases who had peripartum hysterectomy, 16 cases were delivered by caesarean section and 4 cases delivered by vaginal route while another 4 cases delivered by laparotomy for rupture uterus. 22 cases (91.67%) survived with major number of cases having morbidities and there were 2 (8.33%) maternal death.Conclusions: The most common mode of delivery before peripartum hysterectomy was Caesarean section. The most common indication was atonic postpartum haemorrhage. Better protocols for induction and augmentation of labour will decrease the necessity of peripartum hysterectomies.

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 In Mendefera Hospital-Case Control Study

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.

scholarly journals Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 111
Author(s):  
Nicolae Gică ◽  
Carina Ragea ◽  
Radu Botezatu ◽  
Gheorghe Peltecu ◽  
Corina Gică ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Morbidity Rate ◽  
Maternal Outcomes ◽  
Peripartum Hysterectomy ◽  
Cesarean Deliveries ◽  
Life Saving ◽  
Emergency Peripartum Hysterectomy ◽  
Placenta Accreta Spectrum

Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.

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.

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