emergency hysterectomy
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2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Zhuanji Fang ◽  
Huale Zhang ◽  
Shuisen Zheng ◽  
Lingling Weng ◽  
Jianying Yan

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.


2021 ◽  
pp. 24-25
Author(s):  
Indrani Roy ◽  
Sr Ancy M. Kurian

Placental polyp is one of the rare diseases that can affect women after delivery or abortion for indenite period which forms a polypoidal mass in the uterus.1 The incidence of placental polyp is less than 0.25% of all pregnancies.2 The case report is of a 41 year old woman, G8 P6L6 A1 who presented on postpartum day 19 and 30 with secondary postpartum haemorrhage. She underwent check curettage on postpartum day 19 and was discharged. And had to undergo emergency hysterectomy on postpartum day 32 as she presented in shock due to secondary postpartum haemorrhage and the histopathologic ndings were compatible with a placental polyp. Placental polyp can be missed on ultrasound and blind procedure like curettage and histopathology gives a conrmatory diagnosis. In our study, the diagnosis was conrmed by histopathology.


2021 ◽  
Author(s):  
Grant Murewanhema ◽  
Tapuwa Carol Musiniwa ◽  
Maxwell Takura Chimhina ◽  
Simbarashe Madombi ◽  
Munyaradzi Innocent Nyakanda ◽  
...  

Abstract BackgroundMalaria in pregnancy is associated with significant morbidity and mortality, and requires early diagnosis and intervention. Plasmodium falciparum is responsible for 98% of malaria cases in Zimbabwe and causes the most severe disease. Abnormal haematological parameters are a frequent finding in patients with malaria; however, they are rarely the sole presenting feature. Case presentationWe present the case of a 32-year-old woman in her fifth pregnancy, with a history of one previous caesarean section, who presented for caesarean section and was incidentally noted to have severe thrombocytopenia. Subsequent investigations at a tertiary institution revealed a pancytopenia with thrombocytopenia as the most prominent feature in an asymptomatic patient. The unavoidable caesarean section done under platelet cover was eventful, with severe intractable haemorrhage necessitating an emergency hysterectomy. However, the patient made a full recovery with antimalarial treatment and blood product transfusions. ConclusionThis case is presented to illustrate the need to consider malaria as a differential diagnosis in pregnant patients from malaria-transmitting areas who have thrombocytopenia. Previous studies have shown that thrombocytopenia can be a predictor of malaria in patients who present with fever, and a marker of disease severity, but has no utility in prognostication and follow-up.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucie Giblin ◽  
Nicola Vousden ◽  
Hannah Nathan ◽  
Francis Gidiri ◽  
Shivaprasad Goudar ◽  
...  

Abstract Background Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds. Methods This is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities. Results Between April 1 2016 and Nov 30th, 2017 536,223 women attended maternity care facilities. Overall, 3.7% (n = 2784/74,828) of women seen in peripheral maternity facilities were referred to higher level care in the control period compared to 4.4% (n = 3212/73,371) in the intervention period (OR 0.89; 0.39–2.05) (data for nine sites that were able to collect denominator). Of these 0.29% (n = 212) pre-intervention and 0.16% (n = 120) post-intervention were referred to higher-level facilities for maternal haemorrhage. Although overall referrals did not significantly reduce there was a significant reduction in referrals for obstetric haemorrhage (OR 0.56 (0.39–0.65) following introduction of the device with homogeneity (i-squared 26.1) between sites. There was no increase in any bleeding-related morbidity (maternal death or emergency hysterectomy). Conclusions Referrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of shock index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings. Trial registration This study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016).


Author(s):  
Beate Hüner ◽  
Krisztian Lato ◽  
Frank Reister ◽  
Wolfgang Janni ◽  
Miriam Deniz

AbstractA cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases. We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.


Perfusion ◽  
2021 ◽  
pp. 026765912110032
Author(s):  
Porntipa Tantibundit ◽  
Manasicha Mekjarasnapha ◽  
Aksorn Pulnitiporn ◽  
Adhus Jirasavetakul

Introduction: Maternal cardiac arrest is a rare condition. Cardiopulmonary resuscitation (CPR) in pregnancy is different from that in other populations due to physiological changes in patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended in patients having cardiac arrest with potentially reversible etiologies. However, data regarding ECPR in pregnancy are limited. Case summary: A 24-year-old woman with a 33-week twin pregnancy developed witnessed cardiac arrest in an antenatal clinic. She underwent perimortem cesarean delivery (PMCD) and ECPR, but uterine atony with massive bleeding occurred. Emergency hysterectomy and massive blood transfusion were performed in the emergency department and the patient was transferred to the intensive care unit after hemodynamics was stable. Conclusion: Cardiac arrest in pregnancy is a complex condition. Several aspects of management have not been evaluated. Prospective studies for improving the outcomes are needed.


2021 ◽  
pp. 109352662199333
Author(s):  
Brenda F Narice ◽  
Martyna Trzeszcz ◽  
Marta Cohen ◽  
Dilly O Anumba

Optimal management of intrauterine infection to avoid serious adverse perinatal outcomes entails prompt administration of antibiotics and consideration of early delivery of the fetus to remove the focus of infection. We report an unusual case of preterm chorioamnionitis which did not improve with sensitive antibiotics, or delivery of the fetus, and ultimately required an emergency hysterectomy to save the mother’s life. Interestingly, subsequent histopathological analysis of the post-hysterectomy specimen did not reveal myometrial necrosis or infectious microorganisms. The placental pathological examination, on the other hand, showed evidence of necrotising chorioamnionitis accompanied by a rarely reported lesion: acute villitis with abundant intravascular Escherichia coli, a finding which is strongly associated with fetal demise and adverse maternal outcomes.


2020 ◽  
Author(s):  
Grant Murewanhema ◽  
Tapuwa Carol Musiniwa ◽  
Maxwell Takura Chimhina ◽  
Simbarashe Madombi ◽  
Munyaradzi Innocent Nyakanda ◽  
...  

Abstract Background Malaria in pregnancy is associated with significant morbidity and mortality, and requires early diagnosis and intervention. Plasmodium falciparum is responsible for 98% of malaria cases in Zimbabwe and causes the most severe disease. Abnormal haematological parameters are a frequent finding in patients with malaria; however, they are rarely the sole presenting feature. Case presentation We present the case of a 32-year-old woman in her fifth pregnancy, with a history of one previous caesarean section, who presented for caesarean section and was incidentally noted to have severe thrombocytopenia. Subsequent investigations at a tertiary institution revealed a pancytopenia with thrombocytopenia as the most prominent feature in an asymptomatic patient. The unavoidable caesarean section done under platelet cover was eventful, with severe intractable haemorrhage necessitating an emergency hysterectomy. However, the patient made a full recovery with antimalarial treatment and blood product transfusions. Conclusion This case is presented to illustrate the need to consider malaria as a differential diagnosis in pregnant patients from malaria-transmitting areas who have thrombocytopenia. Previous studies have shown that thrombocytopenia can be a predictor of malaria in patients who present with fever, and a marker of disease severity, but has no utility in prognostication and follow-up.


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