A retrospective analysis of emergency hysterectomy intervention strategy in obstetrics

Objectives: To investigate the indications of obstetric emergency hysterectomy and analyze the clinical effects of subtotal hysterectomy and total hysterectomy. Methods: We included 247 hospitalized women who had undergone abdominal hysterectomy due to obstetric reasons in Fujian Province Maternity and Child Health Hospital (a provincial class-A hospital) and Ningde People’s Hospital (a primary Class-B hospital) between January 2002 and December 2018. We identified surgical indications and clinical characteristics of the patients. Furthermore, the patients from Fujian Provincial Maternity and Child Health Hospital were subdivided into subtotal hysterectomy group and total hysterectomy group to examine general operation conditions, and postoperative complications. Results: The main surgical indications for emergency obstetric hysterectomy in Fujian Maternity and Child Health Hospital were placental implantation (49.6%) and uterine weakness (31.9%), while uterine weakness (37.5%) was the most important indication in Ningde People’s Hospital. No differences were found in operation time, hospitalization time, intraoperative blood loss, postpartum blood loss, and intraoperative fresh frozen plasma transfusion between the subtotal hysterectomy group and the total hysterectomy group. Postoperative test parameters, including postoperative prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), hemoglobin (HGB), and hematocrit (HCT), were not significantly different between the two groups. No significant difference was noted in postoperative vesicoureteral injury, pelvic hematoma, infection, and disseminated intravascular coagulation (DIC) incidence, but renal failure incidence was different (P=0.040). Conclusion: The treatment effect of subtotal hysterectomies for the cases without placenta accreta and placenta previa was similar in the two hospitals. There is no statistically significant difference in therapeutic effect between total hysterectomy and subtotal hysterectomy. doi: https://doi.org/10.12669/pjms.38.3.5335 How to cite this:Fang Z, Zhang H, Zheng S, Weng L, Yan J. A retrospective analysis of emergency hysterectomy intervention strategy in obstetrics. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5335 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when?

Purpose The rates of hysterectomy are falling worldwide, and the surgical approach is undergoing a major change. To avoid abdominal hysterectomy, a minimally invasive approach has been implemented. Due to the increasing rates of subtotal hysterectomy, we are faced with the following questions: how often does the cervical stump have to be removed secondarily, and what are the indications? Methods This was a retrospective, single-centre analysis of secondary resection of the cervical stump conducted from 2004 to 2018. Results Secondary resection of the cervical stump was performed in 137 women. Seventy-four percent of the previous subtotal hysterectomy procedures were performed in our hospital, and 26% were performed in an external hospital. During the study period, 5209 subtotal hysterectomy procedures were performed at our hospital. The three main indications for secondary resection of the cervical stump were prolapse (31.4%), spotting (19.0%) and cervical dysplasia (18.2%). Unexpected histological findings (premalignant and malignant) after subtotal hysterectomy resulted in immediate (median time, 1 month) secondary resection of the cervical stump in 11 cases. In four patients, the indication was a secondary malignant gynaecological disease that occurred more than 5 years after subtotal hysterectomy. The median time between subtotal hysterectomy and secondary resection of the cervical stump was 40 months. Secondary resection of the cervical stump was performed vaginally in 75.2% of cases, laparoscopically in 20.4% of cases and abdominally in 4.4% of cases. The overall complication rate was 5%. Conclusion Secondary resection of the cervical stump is a rare surgery with a low complication rate and can be performed via the vaginal or laparoscopic approach in most cases. The most common indications are prolapse, spotting and cervical dysplasia. If a secondary resection of the cervical stump is necessary due to symptoms, 66.6% will be performed within the first 6 years after subtotal hysterectomy.

Uterine stump leiomyosarcoma after sub-total hysterectomy: a case report

Introduction: Uterine sarcomas considered as one of the aggressive tumors of uterine malignancies. It is one of the mesenchymal tumors that originate from smooth muscle of the uterus which is a rare tumor that accounts for 2% to 5% of all uterine malignancies. Very few cases are reported in the literature. Our patient has a unique history of Pelvic-Abdominal swelling reaching xiphisternum level after subtotal hysterectomy one year ago. Abnormal genital bleeding not responding to medical treatment is the usual presentation in uterine sarcoma like in our patient. We report an original case report of an abnormal sequence of this rare tumor arising from the uterine stump after subtotal hysterectomy. Case presentation: A 42-year-old nulliparous woman presented to our gyne-oncology unit in El-Galaa Maternity Teaching Hospital in June 2020 with a significant rapid increase in abdominal circumference, symptoms caused by abdominal pressure (vomiting and constipation) and abnormal genital bleeding after laparotomic sub-total hysterectomy one year ago. Tumor marker CA-125 was raised, LDH was raised and a MRI scan showed a huge mass arising from the pelvis. An exploratory laparotomy was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma weighing around 22kg. Conclusion: Because of their rarity, uterine sarcomas are not suitable for screening. Diagnosis by histopathologic examination and surgery is the only treatment. Pre-operative MRI with contrast for abdomen and pelvis is highly recommended to exclude abdomen metastatic sarcoma if the tumor is confined to the pelvis only.

Emergency peripartum hysterectomy in a tertiary teaching hospital in Northern Jordan: a 15-year review

Emergency peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum hemorrhage. It is associated with a high rate of maternal morbidity among survivors. This work aims to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over 15 years. A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormally adherent placenta were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The chi-square test, Fisher’s exact, and independent sample T test were used for analysis. Statistical significance was declared at α < 0.05. The incidence of peripartum hysterectomy was 1.38 per 1000 births. Fifty-nine were performed after cesarean section and three were performed after vaginal delivery (P<0.001). Abnormally adherent placenta (accreta, increta, and percreta) was the main indication (44.06%). The strongest risk factor for abnormally adherent placenta was placenta previa with previous cesarean section (P=0.001, OR 16.25, 95% CI 1.95-135.01). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (27.11%). No difference in morbidity was noted between total and subtotal hysterectomy. The incidence of emergency peripartum hysterectomy is increasing steadily over the last two decades in the north of Jordan. Abnormally adherent placenta is the most common indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications’ development, admission to the intensive care unit, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant.

Emergency peripartum hysterectomy in a tertiary teaching hospital in Northern Jordan: a 15-year review

Background Emergency Peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum haemorrhage. It is associated with a high rate of maternal morbidity among survivors. The aim of this work is to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over a 15-year period. Methods A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormal placentation were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The Chi-square test, Fisher’s exact and Independent Sample T-Test were used for analysis. Statistical significance was declared at α < 0.05. Results The incidence of peripartum hysterectomy was 1.46 per 1000 births. Sixty-three were performed after caesarean section and three were performed after vaginal delivery (P < 0.001). Abnormal placentation (accreta, increta and percreta) was the main indication (46.03%). The strongest risk factor for abnormal placentation was placenta previa with previous caesarean section (P < 0.001, OR 17.33, 95% CI 2.09–143.14). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (26.98%). No difference in morbidity noted between total and subtotal hysterectomy. Conclusions The incidence of emergency peripartum hysterectomy in increasing steadily over the last two decades in the north of Jordan. Abnormal placentation is the commonest indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications` development, admission to the ICU, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant.

Learning curve analysis of applying Seprafilm hyaluronic acid/carboxymethylcellulose membrane during laparoscopic hysterectomy

This study was designed to evaluate the learning curve of applying Seprafilm (modified hyaluronic acid and carboxymethylcellulose; Genzyme, Cambridge, MA, USA) during laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy. In this retrospective cohort study, 35 patients who underwent laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy were enrolled. The Seprafilm was cut into 4 pieces, rolled up with a trimmed plastic sleeve and delivered through an incision wound made for the 5-mm ancillary trocar. The membrane was unrolled and placed on the rough surface after hysterectomy or subtotal hysterectomy with or without adnexectomy. The time from the insertion of the first piece of membrane into the abdominal cavity to the complete removal of the trimmed plastic sleeve was recorded. The median time for Seprafilm placement was 3 min. The learning curve was analyzed using the power-law method and suggested that 10 cases were required to achieve proficiency in the procedure. The presence of adnexectomy was significantly associated with the time required for Seprafilm placement (P < 0.001). Although Seprafilm placement is more complicated compared to the liquid and gel forms of anti-adhesion barriers, surgical proficiency seemed to be attained after 10 cases for an experienced surgeon.

Total Versus Subtotal Hysterectomy for Benign Uterine Disease: Which Advantages

BACKGROUND: to evaluate the impact of total vs subtotal hysterectomy on vaginal bleeding and intestinal, sexual and bladder disfunction.METHODS: observational study conducted on women who underwent hysterectomy for benign uterine disease at S. Andrea university hospital in Rome between July 2013 and December 2017.We selected 236 women that underwent hysterectomy for benign disease to submit a validated questionnaire during the follow up evaluation at 12 months from the surgery. One hundred and sixty-two accepted to answer (84 subtotal hysterectomy, 78 total hysterectomy).RESULTS: Twenty-one percent (n=18) of subtotal hysterectomy (SAH) and eight percent (n=6) of total(TAH) showed vaginal bleeding (p=0,015). The difference was not statistically significant for pelvic pain,nausea, alvus changes and urinary incontinence.Thirteen percent (n=10) of women subjected to subtotal hysterectomy and twenty-nine percent (n=21) ofthe totals has declared to experience pain during sexual intercourse (p=0,0159). Thirty-one percent(n=22) of TAH noted a deterioration in the quality of sex intercourses (p=0.026).Concomitant bilateral salpingo-ovariectomy, compared to salpingectomy alone, resulted in an increase in sexual dysfunction for all the analyzed outcomes with a statistically significant difference in the group of total hysterectomies (perception of pain during intercourse [p=0,029], worse quality [p=0,015] and alteredvaginal length [p=0,003]).CONCLUSION: SAH is superior to TAH in terms of sexual function but is related to more vaginalbleeding. There are no differences between the groups regarding bowel and bladder function and thedevelopment of other symptoms after surgery. For these reasons the type of surgery should be decided bythe patient after accurate medical counselling, minimizing, the incidence of salpingo-ovariectomy associatedwith hysterectomy.