Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & c...Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & complications of peripartum hysterecomty performed in a tertiary care hospital & compare the results with other reports in the literature. Methods: Twenty nine peripartum hysterectomy cases carried out between July 2015 and June 2018 in Enam Medical College & Hospital, Savar, Dhaka were evaluated retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results: Peripartum hysterectomy incidence was found as 7.26 per 1000 deliveries. The most common indication for hysterectomy was placenta previa with morbidly adherent placenta (17/29) followed by post-partum haemorrhage due to uterine atony (6/29) and ruptured uterus (6/29). There were 6 cases of intraoperative bladder injury. We had 5 maternal deaths, 3 of them were due to irreversible shock & 2 due to septicaemia. There were 5 cases of neonatal mortality mostly because of prematurity & asphyxia. All of the placenta previa with placenta accreta cases had at least one previous cesarean section. All 6 ruptured uterus cases had history of previous caesarean section. It was found that blood transfusion was required in all cases. Conclusion: Obstetric hemorrhages are life-threatening clinical conditions & peripartum hysterectomy is a necessary life-saving procedure. Abnormal placentation is the leading cause of emergency peripartum hysterectomy specially in cases with previous cesarean section history.展开更多
Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth;it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the inc...Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth;it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the incidence of peripartum hysterectomy in Misan province, what is the main cause of this procedure, and if there is any change in the incidence of this procedure during a 3 year study period. Method: A descriptive cross sectional study was done in Misan province for all cases of peripartum hysterectomy during the period from 2014-2016. All information regarding present pregnancy, previous obstetric history, the cause of peripartum hysterectomy, any complications & infant outcome, were taken from the case sheet & from the patients themselves. 50 patients were enrolled in this study, and only 30 patients needed peripartum hysterectomy and 20 patients’ uterus were saved by repair surgery. Results: During the study period of 3 years, there was 72,720 deliveries, and during that time 30 peripartum hysterectomies were carried out of the 50 cases studied, which gave an incidence of 0.4/1000 deliveries. The patients were diagnosed as: rupture uterus in 30 (60%) cases, adherent placenta in 14 (28%) & 6 (12%) cases had atonic uterus. The major postoperative complication was anemia which complicated 23 (46%) cases, & then bladder injury 5 (10%). Admission to ICU was needed for 24 (48%) cases. There were 32 (64%) cases needed ≥4 units of blood transfusion. There were 38 (76%) cases stayed in hospital for ≥4 days. The most common cause for peripartum hysterectomy was for adherent placenta (28%) & rupture uterus (20%). Conclusion: The incidence of peripartum hysterectomy was 0.4/1000 (0.04%) deliveries. The most common reason behind peripartum hysterectomy was for adherent placenta and next was for uterine rupture. The rate of this procedure was not changed during the study period.展开更多
Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH...Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine （IPMCH）.The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P＜0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was （5 060.7±3 032.6）ml,and that of the control group was （2 040.8±723.5） ml.There was a significant difference of PHH between the EHP group and the control group （P=0.001）.Independent risk factors for EPH from a logistic regression model were：disseminated intravascular coagulation （DIC） （OR：9.9,95％ CI 2.8-34,P=0.003）,previous cesarean section （OR：5.27;95％ CI：1.48-17.9,P=0.009）,placenta previa （OR：6.9; 95％ CI 1.6-2.9,P=0.008）,the loss of PPH （OR：1.001; 95％ CI 1.001-1.002,P=0.002）,placenta accreta （OR：68; 95％ CI 10-456,P=0.004）,the use of tocolytic agents prenatally （OR：6.55,95％CI 1.34-32.1,P=0.049）,and fetal macrosomia （OR：6.9,95％ CI 1.25-38,P=0.049）.Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.展开更多
文摘Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & complications of peripartum hysterecomty performed in a tertiary care hospital & compare the results with other reports in the literature. Methods: Twenty nine peripartum hysterectomy cases carried out between July 2015 and June 2018 in Enam Medical College & Hospital, Savar, Dhaka were evaluated retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results: Peripartum hysterectomy incidence was found as 7.26 per 1000 deliveries. The most common indication for hysterectomy was placenta previa with morbidly adherent placenta (17/29) followed by post-partum haemorrhage due to uterine atony (6/29) and ruptured uterus (6/29). There were 6 cases of intraoperative bladder injury. We had 5 maternal deaths, 3 of them were due to irreversible shock & 2 due to septicaemia. There were 5 cases of neonatal mortality mostly because of prematurity & asphyxia. All of the placenta previa with placenta accreta cases had at least one previous cesarean section. All 6 ruptured uterus cases had history of previous caesarean section. It was found that blood transfusion was required in all cases. Conclusion: Obstetric hemorrhages are life-threatening clinical conditions & peripartum hysterectomy is a necessary life-saving procedure. Abnormal placentation is the leading cause of emergency peripartum hysterectomy specially in cases with previous cesarean section history.
文摘Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth;it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the incidence of peripartum hysterectomy in Misan province, what is the main cause of this procedure, and if there is any change in the incidence of this procedure during a 3 year study period. Method: A descriptive cross sectional study was done in Misan province for all cases of peripartum hysterectomy during the period from 2014-2016. All information regarding present pregnancy, previous obstetric history, the cause of peripartum hysterectomy, any complications & infant outcome, were taken from the case sheet & from the patients themselves. 50 patients were enrolled in this study, and only 30 patients needed peripartum hysterectomy and 20 patients’ uterus were saved by repair surgery. Results: During the study period of 3 years, there was 72,720 deliveries, and during that time 30 peripartum hysterectomies were carried out of the 50 cases studied, which gave an incidence of 0.4/1000 deliveries. The patients were diagnosed as: rupture uterus in 30 (60%) cases, adherent placenta in 14 (28%) & 6 (12%) cases had atonic uterus. The major postoperative complication was anemia which complicated 23 (46%) cases, & then bladder injury 5 (10%). Admission to ICU was needed for 24 (48%) cases. There were 32 (64%) cases needed ≥4 units of blood transfusion. There were 38 (76%) cases stayed in hospital for ≥4 days. The most common cause for peripartum hysterectomy was for adherent placenta (28%) & rupture uterus (20%). Conclusion: The incidence of peripartum hysterectomy was 0.4/1000 (0.04%) deliveries. The most common reason behind peripartum hysterectomy was for adherent placenta and next was for uterine rupture. The rate of this procedure was not changed during the study period.
文摘Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine （IPMCH）.The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P＜0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was （5 060.7±3 032.6）ml,and that of the control group was （2 040.8±723.5） ml.There was a significant difference of PHH between the EHP group and the control group （P=0.001）.Independent risk factors for EPH from a logistic regression model were：disseminated intravascular coagulation （DIC） （OR：9.9,95％ CI 2.8-34,P=0.003）,previous cesarean section （OR：5.27;95％ CI：1.48-17.9,P=0.009）,placenta previa （OR：6.9; 95％ CI 1.6-2.9,P=0.008）,the loss of PPH （OR：1.001; 95％ CI 1.001-1.002,P=0.002）,placenta accreta （OR：68; 95％ CI 10-456,P=0.004）,the use of tocolytic agents prenatally （OR：6.55,95％CI 1.34-32.1,P=0.049）,and fetal macrosomia （OR：6.9,95％ CI 1.25-38,P=0.049）.Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.
