Evaluation of Parameters that Influence Morbidity in Peripartum Hysterectomy

ABSTRACT Objective To evaluate which factors affect the intraoperative and postoperative morbidity in cases of peripartum hysterectomy. Study design A retrospective study of all cases of peripartum hysterectomy performed during a 5-year period (January 2008–June 2013) in a tertiary maternity hospital. Results A total of 22,437 deliveries were reviewed and 63 cases of peripartum hysterectomy (2.8/1000) were identified. The indications for peripartum hysterectomy included: uterine atony (10 cases—15.9%), placenta accreta (21 cases—33.3%), placenta previa (30 cases—47.6%) and cervical pregnancy (2 cases—3.2%). Significantly higher rates of perioperative blood transfusion were noted in the emergency cases group, compared to the elective hysterectomies. Hypogastric artery ligation did not have any significant impact on the outcome. Preoperative bilateral ureteral catheterization was associated with lower need for blood transfusion (p < 0.001), and with less complications, although this was not statistically significant. Conclusion Maternal morbidity is significantly higher in emergency cases of peripartum hysterectomies compared to expected-planned cases. How to cite this article Daskalakis G, Antsaklis P, PergialiotisV, Rodolakis A, Vlachos G, Loutradis D, Papantoniou N. Evaluation of Parameters that Influence Morbidity Peripartum Hysterectomy. Donald School J Ultrasound Obstet Gynecol 2015;9(3):234-238.

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Peripartum hysterectomy for cesarean section with morbidly adherent placenta: case series of 25 patients

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184115 ◽

2018 ◽

Vol 7 (10) ◽

pp. 3980

Author(s):

Abdulrahman M. Rageh ◽

Mohamed Khalaf ◽

Ahmed M. Abbas ◽

Hossam T. Salem

Keyword(s):

Blood Loss ◽

Placenta Accreta ◽

Placenta Previa ◽

Case Series ◽

Bladder Injury ◽

Operative Blood Loss ◽

Ureteric Injury ◽

Total Blood ◽

Peripartum Hysterectomy ◽

The Mean

Background: The current paper reports the outcome of case series of patients presented with placenta accreta confirmed histopathologicaly after management by peripartum hysterectomy.Methods: The study was set in Women’s Health Hospital, Assiut University, Egypt. This was a case series of 25 women presented with placenta accreta between May 2017 and April 2018. We included all pregnant women with placenta previa as diagnosed by ultrasound with suspicion of abnormal placentation by Doppler, confirmed intra-operatively undergoing either emergent or elective CS. All cases were performed by an expert team of obstetricians and anesthetists. Cesarean delivery was done under general anesthesia through pfannensteil incision. The primary outcome was the estimated intra-operative blood loss through assessment of amount of blood in the suction by ml, difference between the weight of surgical drapes and towels before and after operation.Results: Pre-operative Hb was 10.64±1.01 gm/dL and there was significant decline in the postoperative Hb reaching 8.36±1.21 gm/dL (p<0.001). The mean drop in Hb was 2.28±1.43gm/dL. Estimated intra-operative blood loss was 974.4±398.05 ml in the towels and 847.6±362.56 ml in the suction apparatus. The total blood loss was 1822±653.73 ml. The mean number of units of whole blood transfused was 2160.0±825.6 ml and fresh frozen plasma was 1010.0±349.7 ml. Regarding intra-operative complications, bladder injury was the most common one in 14 cases (56%), followed by ureteric injury in two cases (8%). Postoperative ICU admission was in 6 cases (24%) and the mean duration of hospital stay 12.44 ± 4.07 days. No cases of maternal mortality.Conclusions: In conclusion, peripartum hysterectomy is considered life-saving surgery in patients with placenta accreta.

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A new scoring system for placement of abdominal aortic balloon in Placenta accreta spectrum patients with placenta previa: A retrospective cohort study

10.21203/rs.3.rs-898065/v1 ◽

2021 ◽

Author(s):

Fusen Huang ◽

Jingjie Wang ◽

Qiuju Xiong ◽

Wenjian Wang ◽

Yi Xu ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Scoring System ◽

Placenta Accreta ◽

Placenta Previa ◽

Operation Time ◽

Balloon Occlusion ◽

Abdominal Aortic ◽

Placenta Accreta Spectrum ◽

New Scoring

Abstract Background In recent years, abdominal aortic balloon occlusion is considered an effective method for placenta accreta spectrum patients with placenta previa. However, not all patients in this category require abdominal aortic balloon placement. This study aims to investigate whether the new scoring system is effective for the placement of the abdominal aortic balloon in Placenta accreta spectrum (PAS)patients with placenta previa. Methods PAS patients with placenta previa diagnosed by color Doppler ultrasound were included, and divided into three groups according to their scores graded by a new scoring system (grade Ⅰ group ≤ 5 points, 6 points ≤ grade Ⅱ group ≤ 9 points, grade Ⅲ group ≥ 10 points). Patients with grade Ⅲ were placed with an abdominal aortic balloon unless their families and patients strongly refused. Those with grade I were not placed with an abdominal aortic balloon. Those with grade II generally were not placed with an abdominal aortic balloon unless their families and patients strongly request. Indicators were analyzed, including postpartum hemorrhage, transfusion requirements, operation time, and the ability to preserve the uterus and fertility. Results Estimated blood loss, the number of intraoperative transfused patients, postoperative days were different among the three groups. In group 2 (grade II), there was no significant difference in other observation indexes༈intraoperative blood loss 629 ± 214 vs 758 ± 749, P = 0.488, packed red blood cells47 ± 194 vs 154 ± 445, P = 0.488, admission to ICU 0/7 vs 3/71, P = 1.000, total hysterectomies 0/7 vs 2/71, P = 1.000༉(except for the operation time81.4 ± 19.5 vs 61.7 ± 30.6, P = 0.013) between the abdominal aortic balloon and non-abdominal aortic balloon groups. In group 3 (grade III), significant differences were found in intraoperative blood loss (950 ± 390 vs 2238 ± 1052, P༜0.001), packed red blood cells(213 ± 311 vs 662 ± 528, P༜0.001), postoperative blood transfusion volume(105 ± 181 vs 300 ± 321, P = 0.008), operation time(90.0 ± 25.9 vs 115.9 ± 45.3, P = 0.013), the proportion of people who need blood transfusion(14 in the IABO vs 11 in the NIABO, P = 0.002) and the total Hysterectomies (0 in the IABO vs 2 in the NIABO, P = 0.011) between the abdominal aortic balloon and non-abdominal aortic balloon groups. Conclusion With the new scoring system, not all patients with PAS and placenta previa need a preventive temporary balloon occlusion of the subrenal abdominal aorta. We recommend placing an abdominal aortic balloon in patients with grade III, for it can control intraoperative bleeding and reduce intraoperative blood transfusion, and reduce the risk of hysterectomy. For patients with grade I and II, abdominal aortic balloon placement is not recommended.

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The bleeding mother and her baby: a study to determine the fetomaternal outcome in cases of placenta previa

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203855 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3775

Author(s):

Preeti Frank Lewis ◽

Sana Tarannum Bijapur ◽

Deepika Gurnani

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Uterine Artery ◽

Placenta Previa ◽

Tertiary Care ◽

Previous History ◽

Fetal Outcome ◽

Care Hospital ◽

Artery Ligation ◽

Uterine Artery Ligation

Background: Placenta previa is one of the major causes for obstetric hemorrhagic morbidity and mortality with increasing incidence in recent times. This study aims at determining risk factors, maternal and fetal outcome associated with placenta previa.Methods: This was an observational, retrospective study conducted at a tertiary care hospital in Mumbai from May 2017 to March 2020. A total of 102 women with placenta previa during the study period were included, their case records critically analyzed to identify risk factors, maternal outcome in relation with blood transfusion required, ICU admission, obstetric hysterectomy and fetal outcome pertaining to prematurity, asphyxia and mortality.Results: A total of 102 patients were analyzed. Placenta previa was more common in >26 years of age, multipara (64.7%), with previous history of caesarean sections (21.5%) and previous curettage (11.7%), 44.2% babies born were preterm, 4.4% stillbirths and 8.5% neonatal deaths. Maternal complications like antepartum hemorrhage was seen in 58.8% patients and postpartum hemorrhage in 33.3%, blood transfusion was required in only 18 patients post operatively, bladder rent was seen in 3 patients and there was no maternal mortality. 44 patients required uterine artery ligation, Ashok Anand stitch was taken in 37 patients, uterus compression sutures in 10, obstetric hysterectomy in 7 patients and internal iliac artery ligation in 2 patients.Conclusions: Early identification of women at risk, obstetric preparedness and simple techniques like uterine artery ligation, Ashok Anand stitch and uterine compression sutures can help in effectively reducing need for multiple blood transfusions and morbidity.

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Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0252654 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252654

Author(s):

Sara Ornaghi ◽

Alice Maraschini ◽

Serena Donati ◽

Keyword(s):

Blood Transfusion ◽

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Geographical Area ◽

Perinatal Outcomes ◽

Population Based ◽

Source Population ◽

Italian Regions ◽

Placenta Accreta Spectrum

Introduction Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery. Material and methods This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15–50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. Results A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75–0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients. Conclusions Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.

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Management Placenta Percreta Succesfully With Total Abdominal Hysterectomy. A Case Review :

AVERROUS: Jurnal Kedokteran dan Kesehatan Malikussaleh ◽

10.29103/averrous.v5i1.1628 ◽

2019 ◽

Vol 5 (1) ◽

pp. 52

Author(s):

Rajuddin Rajuddin ◽

Roziana Roziana ◽

Munawar Munawar ◽

Muhammad Iqbal

Keyword(s):

United States ◽

Blood Transfusion ◽

Cesarean Section ◽

Antenatal Care ◽

Placenta Accreta ◽

Placenta Previa ◽

The United States ◽

Placenta Percreta ◽

Risk Of Bleeding ◽

Placenta Accreta Spectrum

Background: Placenta accreta spectrum is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. The management of placenta accrete spectrum will be discussed here and is essentially the same. The following discussion of management of placenta accreta spectrum applies to all depths of placental invasion. Incidence: In 1950 placentaaccreta was rare, occurring 1 in 30.000 deliveries in the United States. Duringbetween 2008 and 2011 in a cohort of over 115.000 deliveries in 25 hospitals in the United States reaching 1 in 731 deliveries. The marked increase has been attributed to the increasing prevalence of cesarean delivery in recent decades.The incidence of placenta accreta spectrum will also increase due to increasing of caesarean section rate. Case: Mrs.44 yo, G3P2 36-37weekslive, previous cesarean section 2 time,placenta previa totalis, placenta percreta. She’s comes with a chief complaint of lower abdominal cramps, patients regularly antenatal care at obstetrician. Ultrasound finding, a single fetus lives at transvers lie, dorso superior, corresponding to 36-37 weeks, placenta previa, placenta percreta (PAI:83%). This patient planned for elective conservative surgery management, due to cesarean section and or cesarean hysterectomy. Discussion:Surgical conservative management giving birth a baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion. The discovery of placenta accreta spectrum earlier when antenatal care, better birth planning than multidisciplinary science includedfetomaternal, gyneco-oncologist, anesthesiologist, thorac& cardiovascular surgeon, radiology intervention, intensivist - obstetric intensive care, urologist and neonatology can determine the success of handling cases of placenta accreta spectrum so as to reduce maternal, fetal morbidity and mortality. Conclusions: The discovery of placenta accreta spectrum earlier when antenatal care, planning delivery is better than multidisciplinary science. Management with corporal incisions away from placental implantation, giving birth baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion.

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Progressive Devascularization: A Novel Surgical Approach for Placenta Previa

American Journal of Perinatology Reports ◽

10.1055/s-0038-1673373 ◽

2018 ◽

Vol 08 (04) ◽

pp. e223-e226

Author(s):

Antonio Saad ◽

Nathan Kirsch ◽

George Saade ◽

Gary Hankins

Keyword(s):

Surgical Approach ◽

Antenatal Diagnosis ◽

Placenta Previa ◽

Multiple Organ ◽

Artery Ligation ◽

Peripartum Hysterectomy ◽

Cesarean Deliveries ◽

Uterine Artery Ligation ◽

Peripartum Hemorrhage ◽

Life Threatening

Background The gold standard for antenatal diagnosis of placenta previa is the transvaginal ultrasonography. In placenta previa cases, separation of placental and uterine tissues is challenging even for the most experienced surgeons. Life-threatening obstetrical complications from cesarean deliveries with placenta previa include peripartum hemorrhage, coagulopathy, blood transfusion, peripartum hysterectomy, and multiple organ failure. Cases We detailed the 3 cases of placenta previa that underwent bilateral uterine artery ligation; if hemostasis was not achieved, horizontal mattress sutures were placed in the lower uterine segment. All patients were discharged with minimal morbidity. Conclusion For patients with placenta previa and low risk for placenta creta, counseling should include the risk for maternal morbidity and criteria for pursuing peripartum hysterectomy. Our devascularization, a stepwise surgical approach, shows promising outcomes in placenta previa cases. Précis We propose a novel surgical approach, using a progressive devascularization surgical technique, for management of women with placenta previa, undergoing cesarean delivery.

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PLACENTA ACCRETA - A MANAGEMENT ENIGMA

10.36106/gjra/2900382 ◽

2019 ◽

pp. 1-3

Author(s):

Bhakti Bawankule ◽

Sushree Patra ◽

Sushil Kumar

Keyword(s):

Caesarean Section ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Placenta Accreta ◽

Placenta Previa ◽

Previous Caesarean Section ◽

Artery Ligation ◽

Internal Iliac Artery Ligation ◽

Internal Iliac ◽

The Mean

AIMS AND OBJECTIVES: 1. To analyse maternal and foetal outcomes 2. To analyse types of interventions. MATERIALS AND METHODS: It is a retrospective study conducted over a period of 3years (Jan2017-August 2019), in Department of Obstetrics & Gynaecology at our hospital. Out of 9000deliveries conducted in 3years, 12patients were found to have accreta during caesarean section. Cases were analysed for interventions and maternal and foetal outcome. RESULTS: The mean age of patient included was 25.7yrs ranging from 21-35 yrs. 7patients were gravida 2, 3were gravida 3 and 2 were gravida 4. The mean gestational age was 34.4 weeks ranging from 27.1 to 37.5 weeks. History of D&C was present in 1case, H/O previous LSCS was present in all cases, H/O placenta previa in current pregnancy was present in7/12 cases. H/O previous caesarean section with placenta previa in this pregnancy was present in 7cases. Hysterectomy alone was done in 9patients. Hysterectomy with Internal Iliac Artery Ligation was done in 3patients. Average blood loss was around 1700 ml & blood transfusion was required in all patients. Total 6 patients required ICU care, with 1maternal death and 2 IUFD. CONCLUSION: Antenatal diagnosis of placenta accreta is a challenge. With increasing frequency of previous caesarean section and placenta previa the prevalence of placenta accreta is increasing. With advent of newer interventions and availability of interventional radiologists death due to massive haemorrhage is reducing. Obstetric hysterectomy and Internal Iliac artery Ligation still remains the mainstay of treatment. However, morbidly adherent placenta is a threat to both patient and obstetrician.

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A COMBINED ULTRASOUND AND CLINICAL SCORING MODEL FOR THE PREDICTION OF PERIPARTUM COMPLICATIONS IN PREGNANCIES COMPLICATED BY PLACENTA PREVIA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i12.43115 ◽

2021 ◽

pp. 73-76

Author(s):

SHREEJI GOYAL ◽

SUJATA SHARMA ◽

ARVINDER SINGH ◽

AMARJEET KAUR

Keyword(s):

Blood Transfusion ◽

Cesarean Delivery ◽

Uterine Artery ◽

Placenta Previa ◽

Artery Ligation ◽

Scoring Model ◽

Uterine Artery Ligation ◽

Clinical Scoring ◽

History Of ◽

Ultrasound Parameters

Introduction: Patients with placenta previa are at an increased risk of uncontrolled hemorrhage. Various clinical and ultrasound parameters can predict the risk of bleeding in these patients. Hence, the objective of our study is to develop a combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa. Methods: Fifty singleton pregnant women with placenta previa who underwent cesarean delivery in our hospital were included in the study. We collected clinical and ultrasound data prospectively, and the score was given to each parameter, and total score correlated with the occurrence of peripartum complications. Clinical parameters included age, parity, history of dilatation and evacuation, previous cesarean delivery, history of placenta previa, antepartum hemorrhage, and ultrasound parameters included type of previa, no. of lacunae in placenta, uteroplacental hypervascularity. The peripartum complications noted were the need for blood transfusion, uterine artery ligation, and cesarean hysterectomy. Results: According to the composite scoring done, uterine artery ligation was needed in more than 50% of patients at a score of 9–10. It increased to 100% as the score increased to ≥11. At a score of ≥12, hysterectomy was needed in around 75% of patients, and 100% of patients needed a blood transfusion. Univariate analysis using the Pearson Chi-square test was also done to know whether individual parameters and peripartum complications were significantly related that is p<0.05 with one another. Conclusion: The scoring system may serve to predict peripartum complications in pregnancies complicated by placenta previa.

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Incisión Fúndica Uterina con Histerectomía y Ligadura de Arterias Hipogástricas para manejo de Placenta Previa con Acretismo: A propósito de un caso.

Revista Medica Vozandes ◽

10.48018/rmv302.8 ◽

2019 ◽

Vol 30 (2) ◽

Author(s):

Yajaira Belalcázar

Keyword(s):

Caesarean Section ◽

Blood Transfusion ◽

Clinical Case ◽

Placenta Previa ◽

Intensive Therapy ◽

Hypogastric Artery ◽

Third Trimester ◽

Artery Ligation ◽

The Third ◽

Risk Of Hemorrhage

The placenta previa with acretism is a pathology with high morbimortality that can be diagnosed in the third trimester of pregnancy by image, which allows to program its resolution by caesarean section. A clinical case of a 40-year-old female patient presenting a 36.5-week pregnancy with total occlusive placenta with signs of accretion determined by ultrasound and resonance is presented, considering the risk of hemorrhage, a caesarean section was scheduled by means of a uterine fundal incision and at the placenta is not spontaneously detached, bilateral hypogastric artery ligation and obstetric hysterectomy are performed. This surgery is performed without complications or the need for blood transfusion or admission of the patient to intensive therapy.

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Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

Journal of Robotic Surgery ◽

10.1007/s11701-021-01262-z ◽

2021 ◽

Author(s):

Antonio Benito Porcaro ◽

Riccardo Rizzetto ◽

Nelia Amigoni ◽

Alessandro Tafuri ◽

Aliasger Shakir ◽

...

Keyword(s):

Radical Prostatectomy ◽

Blood Transfusion ◽

Blood Loss ◽

Univariate Analysis ◽

Operating Time ◽

Primary Treatment ◽

Intraoperative Blood Loss ◽

Robot Assisted ◽

Intraoperative Bleeding ◽

Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

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