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

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

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ECLAMPSIA, A MAJOR BURDEN ON MATERNAL AND CHILD HEALTH: A RETROSPECTIVE STUDY IN TERTIARY CARE CENTRE

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2017/59 ◽

2017 ◽

Vol 4 (6) ◽

pp. 311-315 ◽

Cited By ~ 2

Author(s):

Kanchan Rani ◽

Mukesh Kumar Prasad ◽

Vandana Bisht

Keyword(s):

Retrospective Study ◽

Child Health ◽

Maternal And Child Health ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

And Child Health

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Peripartum Hysterectomy: A Review of 70 Cases

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1022 ◽

2009 ◽

Vol 1 (2) ◽

pp. 19-21

Author(s):

Shaheen LNU ◽

Rajyashri Sharma ◽

Jayshree Pathak

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Clinical Condition ◽

Age Group ◽

Average Period ◽

Peripartum Hysterectomy ◽

Medical College ◽

Emergency Peripartum Hysterectomy ◽

Emergency Hysterectomy ◽

Indications And Complications

ABSTRACT Objectives To study the incidence, indications and complications of peripartum hysterectomy. Methods A retrospective analysis of 70 cases of emergency peripartum hysterectomy performed over a period of five years from January 2004 to September 2008. At JN Medical College and Hospital AMU Aligarh was done. Results The incidence of emergency hysterectomy was 0.54%. The main indications were uterine atony 26 (37.12%) and Rupture uterus 19 (26.7%). Thirty six (51.43%) were in the age group of 26-35 years and majority of cases 61 (67.14%) were unbooked. The maternal and perinatal mortality was four (5.7%) and 44 (62.86%) respectively. The average period of hospital stay was 10 days. Conclusion Prompt performance of obstetric hysterectomy before the patient's clinical condition deteriorates is the main key to success and less postoperative complications.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181915 ◽

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.

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Improving Maternal and Child Health Care: A Blueprint for Community Action in Pittsburgh Region: Summary

PsycEXTRA Dataset ◽

10.1037/e563542010-001 ◽

2005 ◽

Author(s):

Harold Alan Pincus ◽

Stephen B. Thomas ◽

Donna J. Keyser ◽

Nicholas Castle ◽

Jacob W. Dembosky ◽

...

Keyword(s):

Health Care ◽

Child Health ◽

Maternal And Child Health ◽

Community Action ◽

Child Health Care ◽

And Child Health

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The Maternal and Child Health Bureau's Initiative for Mental Health in Schools

PsycEXTRA Dataset ◽

10.1037/e573382011-001 ◽

1998 ◽

Keyword(s):

Mental Health ◽

Child Health ◽

Maternal And Child Health ◽

Mental Health In Schools ◽

And Child Health

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Child Abuse and Neglect: Maternal and Child Health Fact Sheet

PsycEXTRA Dataset ◽

10.1037/e665322007-001 ◽

2013 ◽

Keyword(s):

Child Abuse ◽

Child Health ◽

Maternal And Child Health ◽

Child Abuse And Neglect ◽

Fact Sheet ◽

Abuse And Neglect ◽

And Child Health

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Maternal and child health nurses’ experiences of implementing two community-based breastfeeding interventions in Victoria, Australia: A mixed methods process evaluation

Australian Journal of Child and Family Health Nursing ◽

10.33235/ajcfhn.16.1.4-14 ◽

2019 ◽

Vol 16 (1) ◽

pp. 4-14 ◽

Cited By ~ 1

Author(s):

Rhian L Cramer ◽

Helen L McLachlan ◽

Touran Shafiei ◽

Lisa H Amir ◽

Meabh Cullinane ◽

...

Keyword(s):

Child Health ◽

Maternal And Child Health ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Breastfeeding Initiation ◽

Structured Interviews ◽

Breastfeeding Support ◽

Community Based ◽

Significant Drop ◽

And Child Health

Despite high rates of breastfeeding initiation in Australia, there is a significant drop in breastfeeding rates in the early postpartum period, and Australian government breastfeeding targets are not being met. The Supporting breastfeeding In Local Communities (SILC) trial was a three-arm cluster randomised trial implemented in 10 Victorian local government areas (LGAs). It aimed to determine whether early home-based breastfeeding support by a maternal and child health nurse (MCH nurse) with or without access to a community-based breastfeeding drop-in centre increased the proportion of infants receiving ‘any’ breast milk at four months. Focus groups, a written questionnaire and semi-structured interviews were undertaken to explore the interventions from the perspective of the SILC-MCH nurses (n=13) and coordinators (n=6), who established and implemented the interventions. Inductive thematic analysis was used to identify themes, then findings further examined using Diffusion of Innovations Theory as a framework. SILC-MCH nurses and coordinators reported high levels of satisfaction, valuing the opportunity to improve breastfeeding in our community; and having focused breastfeeding time with women in their own homes. They felt the SILC interventions offered benefits to women, nurses and the MCH service. Implementing new interventions into existing, complex community health services presented unforeseen challenges, which were different in each LGA and were in part due to the complexity of the individual LGAs and not the interventions themselves. These findings will help inform the planning and development of future programs aimed at improving breastfeeding and other interventions in MCH.

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