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Wang Y, Zhang S. Reflections on peripartum hysterectomy: A 10-year retrospective observational study in Northeast China. Int J Gynaecol Obstet 2024; 165:764-771. [PMID: 37964420 DOI: 10.1002/ijgo.15241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China. METHODS This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed. RESULTS Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies. CONCLUSION Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high-risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH.
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Affiliation(s)
- Yang Wang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuo Zhang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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de Vries P, Deneux-Tharaux C, Caram-Deelder C, Goffinet F, Henriquez D, Seco A, van der Bom J, van den Akker T. Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands. Prev Med Rep 2024; 40:102665. [PMID: 38435415 PMCID: PMC10907197 DOI: 10.1016/j.pmedr.2024.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Objectives Among women with severe PPH (sPPH) in France and the Netherlands, we compared incidence of adverse maternal outcome (major obstetric hemorrhage (≥2.5L blood loss) and/or hysterectomy and/or mortality) by mode of delivery. Second, we compared use and timing of resuscitation and transfusion management, second-line uterotonics and uterine-sparing interventions (intra-uterine tamponade, compression sutures, vascular ligation, arterial embolization) by mode of delivery. Methods Secondary analysis of two population-based studies of women with sPPH in France and the Netherlands. Women were selected by a harmonized definition for sPPH: (total blood loss ≥ 1500 ml) AND (blood transfusion of ≥ 4 units packed red blood cells and/or multicomponent blood transfusion). Findings Incidence of adverse maternal outcome after vaginal birth was 793/1002, 9.1 % in the Netherlands versus 88/214, 41.1 % in France and 259/342, 76.2% versus 160/270, 59.3% after cesarean. Hemostatic agents such as fibrinogen were administered less frequently (p < 0.001) in the Netherlands (vaginal birth: 83/1002, 8.3% versus 105/2014, 49.5% in France; cesarean: 47/342, 13.7% and 152/270, 55.6%). Second-line uterotonics were started significantly later after PPH-onset in the Netherlands than France (vaginal birth: 46 versus 25 min; cesarean: 45 versus 18 min). Uterine-sparing interventions were less frequently (p < 0.001) applied in the Netherlands after vaginal birth (394/1002,39.3 %, 134/214, 62.6%) and cesarean (133/342, 38.9 % and 155/270, 57.4%), all initiated later after onset of refractory PPH in the Netherlands. Interpretation Incidence of adverse maternal outcome was higher among women with sPPH in the Netherlands than France regardless mode of birth. Possible explanatory mechanisms are earlier and more frequent use of second-line uterotonics and uterine-sparing interventions in France compared to the Netherlands.
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Affiliation(s)
- P.L.M. de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C. Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS UMR 1153, Paris, France
| | - C. Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - F. Goffinet
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS UMR 1153, Paris, France
| | - D.D.C.A. Henriquez
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A. Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - J.G. van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T. van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
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Adamec A, Vargova M, Kristufkova A, Niznanska Z, Korbel M. Peripartum hysterectomy: A 9-year population-based study in Slovakia. Int J Gynaecol Obstet 2024; 164:236-241. [PMID: 37485694 DOI: 10.1002/ijgo.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. METHODS This was a descriptive, population-based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. RESULTS Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. CONCLUSION The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage.
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Affiliation(s)
- Adam Adamec
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Maria Vargova
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alexandra Kristufkova
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Niznanska
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Miroslav Korbel
- 1st Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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Gulia KK, Sreedharan SE. Yoga Nidra, a Nonpharmacological Technique in Management of Insomnia and Overall Health in Postmenopausal Women. Sleep Med Clin 2023; 18:463-471. [PMID: 38501518 DOI: 10.1016/j.jsmc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Yoga Nidra is a promising technique through which body is consciously simulated into a profound relaxation state similar to attained during naturally occurring deep sleep. It is aimed to attain complete emotional, physical, and mental relaxation of body and mind. In postmenopausal phase of life, regular practice of Yoga Nidra at home preferably in morning, can help in reduction in anxiety and pain associated with early morning awakenings. This nonpharmacological technique has a therapeutic potential to improve sleep quality and quantity, and overall well-being.
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Affiliation(s)
- Kamalesh K Gulia
- Division of Sleep Research, Department of Applied Biology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695012, India.
| | - Sapna Erat Sreedharan
- Department of Neurology, Comprehensive Centre for Sleep Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India
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Akay A, Akdaş Reis Y, Çelik S, Fıratlıgil FB, Engin Üstün Y. Peripartum Hysterectomy Outcomes: Our Eleven-Year Experience at a Tertiary Care Hospital. J Obstet Gynaecol India 2023; 73:185-190. [PMID: 38143966 PMCID: PMC10746615 DOI: 10.1007/s13224-023-01818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/24/2023] [Indexed: 12/26/2023] Open
Abstract
Aim To investigate the outcomes of peripartum hysterectomies (PHs) conducted to prevent maternal morbidity and mortality at a tertiary care hospital with 15,000 deliveries per year. Method Patients who underwent PHs during delivery and/or within 24 h of delivery between the years 2011-2022 were retrospectively evaluated. Hysterectomies not performed in the peripartum period, cases that were managed by methods such as balloon tamponade, compression suture, or arterial ligation rather than hysterectomy, and hysterectomies performed before 20 weeks were excluded. Obstetric and demographic characteristics of the cases, as well as indications and outcomes of PH, were investigated. Results Among the 130 patients who underwent PH, 4 (3.04%) patients delivered vaginally, 1 (0.7%) patient delivered vaginally after cesarean section, 12 (9.2%) patients delivered by primary cesarean section, and 113 (86.9%) patients delivered by secondary cesarean section. Placenta accreta spectrum disorder was the reason for PH in 54.6% (n = 71) of the cases while 16.1% (n = 21) underwent PH due to uterine atony. The PH rate was 0.75 per 1000 births, and the maternal mortality rate was 7.6 per 1000 hysterectomies in this study. Conclusion Obstetricians in developed/ing countries support the active management of the third stage of labor mainly to mitigate the preventable risk factors of post-/peri-partum hemorrhage. The current study suggests that obstetricians need to focus on the placenta in order to reduce PH.
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Affiliation(s)
- Arife Akay
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
- Department of Obstetrics and Gynecology, Bingöl Maternety and Children Hospital, Bingöl, Türkiye
| | - Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Susam Çelik
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
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Sheth V, Vaishnav S, Sapre S, Bhattacharjee R, Raithatha N, Asrani M. Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India. J Obstet Gynaecol India 2023; 73:206-212. [PMID: 38143980 PMCID: PMC10746675 DOI: 10.1007/s13224-023-01842-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/19/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India. Design Retrospective observational and comparative study from single rural tertiary care referral center of western India. Method A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH. Results Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% (p 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% (p 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%(p < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%(p < 0.001) and morbidly adherent placenta increases from 7 to 23%(p 0.007). ICU admission and ventilator support increases from 54 to 79%(p 0.04) and 22% to 70% (p < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% (p 0.5). Conclusion Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.
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Affiliation(s)
- Vishal Sheth
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Smruti Vaishnav
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Shilpa Sapre
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Rumi Bhattacharjee
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Nitin Raithatha
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Manisha Asrani
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
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Alqahtani NH, Albayat MI, Al Nashwan YA, Alnemer AM. Pathologic Profile of Hysterectomy Cases in Saudi Arabia: A Tertiary Center Experience. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:257-263. [PMID: 37533661 PMCID: PMC10393089 DOI: 10.4103/sjmms.sjmms_438_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/24/2022] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Abstract
Background Hysterectomies are increasingly being replaced by more conservative management modalities and are now only used for limited clinical indications. The agreement between these indications and the final pathology is understudied. Objectives This study aimed to correlate the preoperative clinical diagnoses with the pathological findings detected in hysterectomies in Saudi women of different age groups. Materials and Methods This retrospective study analyzed the preoperative clinical indications and the subsequent clinical and pathological data of all hysterectomies conducted at a single tertiary care hospital in the Eastern Province of Saudi Arabia between January 2010 and December 2021. Results There was no decline in the frequency of hysterectomies across the study period. Abnormal uterine bleeding was the most common clinical indication across all age groups, followed by symptomatic fibroid and uterine prolapse in women aged <50 and ≥50 years, respectively. A total of 9.2% of the cases were indicated for therapeutic reasons, either as an emergency procedure for peripartum hemorrhage or for suspected uterine premalignant and malignant lesions. Besides these, 41.2% of patients had more than one pathology, with the most common combination being leiomyoma and adenomyosis (43.4%). The difference in age between malignant and benign cases (52.3 vs. 48.8 years, respectively) was not statistically significant (P = 0.109). Conclusions Most of our cohort had benign lesions. Perceptible misuse of the procedure in this cohort was unlikely, as a large proportion of the patients had more than one pathology corresponding to each clinical indication.
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Affiliation(s)
- Nourah Hasan Alqahtani
- Department of Obstetrics and Gynecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Methal I. Albayat
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yara A. Al Nashwan
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Areej Manssour Alnemer
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Prka M, Habek D, Marton I, Mitrović L, Glavaš E, Potkonjak AM. Peripartum hysterectomy at a tertiary university perinatal center - retrospective analysis of the 25-year period. J Perinat Med 2023; 51:435-436. [PMID: 35947451 DOI: 10.1515/jpm-2022-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Matija Prka
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.,School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Dubravko Habek
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.,School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Ingrid Marton
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.,School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | | | - Edgar Glavaš
- Pediatric Ward, Čakovec County Hospital, Čakovec, Croatia
| | - Ana-Meyra Potkonjak
- Department of Obstetrics and Gynecology, University Hospital Centre "Sestre milosrdnice", Zagreb, Croatia
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Donati S, Buoncristiano M, D’Aloja P, Maraschini A, Corsi Decenti E, Lega I. Uptake and Adherence to National Guidelines on Postpartum Haemorrhage in Italy: The MOVIE before-after Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5297. [PMID: 37047913 PMCID: PMC10093811 DOI: 10.3390/ijerph20075297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Translating evidence-based guidelines into clinical practice is a complex challenge. This observational study aimed to assess the adherence to the Italian national guidelines on postpartum haemorrhage (PPH) and describe the clinical management of haemorrhagic events in a selection of maternity units (MUs) in six Italian regions, between January 2019 and October 2020. A twofold study design was adopted: (i) a before-after observational study was used to assess the adherence to national clinical and organisational key recommendations on PPH management, and (ii) a cross-sectional study enrolling prospectively 1100 women with PPH ≥ 1000 mL was used to verify the results of the before-after study. The post-test detected an improved adherence to 16/17 key recommendations of the guidelines, with clinical governance and communication with family members emerging as critical areas. Overall, PPH management emerged as appropriate except for three recommended procedures that emphasise different results between the practices adopted and the difference between what is considered acquired and what is actually practised in daily care. The methodology adopted by the MOVIE project and the adopted training materials and tools have proved effective in improving adherence to the recommended procedures for appropriate PPH management and could be adopted in similar care settings in order to move evidence into practice.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Alice Maraschini
- Servizio Tecnico Scientifico di Statistica-Italian National Institute of Health, 00161 Rome, Italy;
| | - Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (S.D.); (M.B.); (P.D.); (I.L.)
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Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:35-48. [PMID: 36701608 DOI: 10.1097/aog.0000000000005022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings. DATA SOURCES PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021. METHODS OF STUDY SELECTION Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8,775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting. TABULATION, INTEGRATION, AND RESULTS The meta-analysis included 154 studies: 14,409 emergency peripartum hysterectomies were performed in 17,127,499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1,000 births (95% CI 1.0-1.3). The highest incidence was observed in lower middle-income settings (3/1,000 births, 95% CI 2.5-3.5), and the lowest incidence was observed in high-income settings (0.7/1,000 births, 95% CI 0.5-0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9-42.4), uterine atony (27.0%, 95% CI 24.6-29.5), and uterine rupture (21.2%, 95% CI 17.8-25.0). In lower middle-income countries, uterine rupture (44.5%, 95% CI 36.6-52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5-53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2,706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3-81.9). The most common complications were febrile (29.7%, 95% CI 25.4-34.3) and hematologic (27.5%, 95% CI 20.4-35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5-4.2) and was higher in lower middle-income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9-14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6-1.6). CONCLUSION Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.
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Habek D, Marton I, Prka M, Luetić AT, Vitić M, Jurković AM. Transvaginally surgically treatment of early postpartum hemorrhage caused by lower uterine segment atony. J Perinat Med 2022; 50:933-938. [PMID: 35531792 DOI: 10.1515/jpm-2021-0686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/27/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Prove the success of transvaginal hemostatic procedures in treatment of the early postpartum hemorrhage caused by lower uterine segment atony. METHODS We have conducted a retrospective, clinical study during a 10-year period (2010-2019) in our institution that is tertiary perinatal university center. RESULTS This particular study enrolled total number of 29,543 deliveries with 215 cases of early postpartum hemorrhage (0.72%). Lower uterine segment atony was diagnosed in 44 cases (29.93%) in all uterine atony cases of early postpartum hemorrhage. Hemostatic ligation procedures according to authors: Losickaja in two cases, Hebisch-Huch in 13 cases, Habek in seven cases, Hebisch-Huch + Losickaja in 10 cases. According to our results, hemostatic ligation procedures alone (32 cases; 72.72%) or combined with gauze or ballon tamponade (five cases, 11.36%), have shown to be highly effective in 37 cases (84.09%). CONCLUSIONS Lower uterine segment atony should definitely be identified and understood as a clinical entity. Transvaginal hemostatic approach for surgical treatment of lower uterine segment atony is accessible, minimally invasive, feasible, successful and lifesaving. All of the above-mentioned methods are of great importance in the prevention and treatment of obstetric shock, multiorgan failure, postpartum hysterectomy and finally vital for fertility preservation.
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Affiliation(s)
- Dubravko Habek
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Ingrid Marton
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Matija Prka
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Ana Tikvica Luetić
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Mirjam Vitić
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Ana Marija Jurković
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Catholic University of Croatia, Zagreb, Croatia
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Li R, Somasodiran M, Sun T, Chen C, Long M, Xu D. Efficacy of low extra-abdominal aortic block in cesarean section for placenta accreta spectrum disorders and its effect on the expression of MDA and SOD. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1129-1135. [PMID: 36097781 PMCID: PMC10950110 DOI: 10.11817/j.issn.1672-7347.2022.220118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Placenta accreta spectrum disorders (PAS) refers to a group of abnormalities in placental adhesion and invasion, which may lead to serious complications such as intractable postpartum hemorrhage. The use of low-level extra-abdominal aortic temporary block during cesarean section may reduce intraoperative bleeding in patients with PAS, but it may also cause ischemia-reperfusion injury. In this study, we intend to investigate the efficacy of low extra-abdominal aortic block in cesarean section for placental implantation disease and its effect on malondialdehyde (MDA) level and superoxide dismutase (SOD) activity, and analyze the severity of ischemia-reperfusion injury caused by them. METHODS Pregnant women with invasive placenta accreta spectrum disorders who delivered in the Department of Obstetrics and Gynecology of the Third Xiangya Hospital of Central South University from July 2017 to July 2021, were selected, and they were divided into 2 groups. Group A consisted of those who underwent low extra-abdominal aortic block during cesarean section (n=15) and group B consisted of those who did not undergo extra-abdominal aortic block (n=15). The intraoperative bleeding, blood transfusion, hysterectomy and complication rate, postoperative hospital stay and hospitalization expenses were compared between the 2 groups to analyze the efficacy of abdominal aortic block. The biochemical indexes related to ischemia-reperfusion, MDA content and total superoxide dismutase (T-SOD) activity, were measured at the corresponding time points in both groups. The time points of each test were: in group A, before the block of the low extra-abdominal aorta after delivery (A0), 0 h (A1, when the myometrium was started to be sutured), 0.5 h (A2), 2 h (A3), and 4 h (A4) after the open block; in group B, after delivery of the fetus (B0), 0 h (B1), 0.5 h (B2), 2 h (B3), and 4 h (B4) after the myometrium was started to be sutured. Total duration of abdominal aortic block in group A was also recorded. Both groups were observed for sings of edema, ischemia, necrosis and infection in the limbs after surgery. The severity of ischemia-reperfusion injury caused by abdominal aortic block were determined by detecting the relevant biochemical indexes at different moments of reperfusion. RESULTS The intraoperative bleeding and blood transfusion in group A were less than those in group B, and the difference was statistically significant (P<0.05). There was no significant difference in postoperative hospital stay and hospitalization expenses between the 2 groups (P>0.05). Surgical complications: in group A, the uterus was preserved in all cases, there was 1 bladder injury and 2 pelvic infections; while in group B, there was 1 hysterectomy, 3 bladder injuries, and 3 pelvic infections. Changes in T-SOD and MDA values: compared with A0 before block, the MDA level was significantly elevated in blood at time points A1, A2, and A3, while SOD activity was significantly decreased (P<0.05), and the 2 observed indexes basically returned to A1 level (ischemic period) at 4 h after open block (A4). There was no significant difference in the changes of T-SOD and MDA in group B (P>0.05). Comparison of T-SOD and MDA levels between group A and B: the difference of the 2 indexes was not statistically significant between A0 and B0 (P>0.05), MDA level was not statistically significant between A1 and B1, T-SOD activity at A1 was lower than B1, the difference was statistically significant, at the rest of the same time point, MDA level in group A were higher than that in group B, T-SOD activity in group A were lower than that in group B, the difference was statistically significant (P<0.05). No postoperative limb edema, ischemia, necrosis, or infection occurred in both groups. CONCLUSIONS Low-level extra-abdominal aortic block effectively reduces bleeding and transfusion during cesarean section for placenta accreta spectrum disorders, resulting in a transient MDA elevation and a decrease of SOD activity, which means causing transient ischemia-reperfusion injury without complications such as limb edema, ischemia, necrosis, and infection.
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Affiliation(s)
- Ruizhen Li
- Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | | | - Tao Sun
- Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Chunxia Chen
- Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Mailian Long
- Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Dabao Xu
- Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
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Sallée C, Margueritte F, Marquet P, Piver P, Aubard Y, Lavoué V, Dion L, Gauthier T. Uterine Factor Infertility, a Systematic Review. J Clin Med 2022; 11:jcm11164907. [PMID: 36013146 PMCID: PMC9410422 DOI: 10.3390/jcm11164907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.
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Affiliation(s)
- Camille Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
- Correspondence: ; Tel.: +33-555-055-555
| | - François Margueritte
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 78103 Poissy, France
| | - Pierre Marquet
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042 Limoges, France
| | - Pascal Piver
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Yves Aubard
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Tristan Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
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Pettersen S, Falk RS, Vangen S, Nyfløt LT. Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital-based study. Acta Obstet Gynecol Scand 2022; 101:819-826. [PMID: 35388907 DOI: 10.1111/aogs.14358] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies. MATERIAL AND METHODS Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy. RESULTS The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications). CONCLUSIONS The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications.
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Affiliation(s)
- Silje Pettersen
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lill T Nyfløt
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics, Drammen Hospital, Drammen, Norway
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Ashwal E, Amikam U, Wertheimer A, Hadar E, Attali E, Dayan DBA, Aviram A, Yogev Y, Hiersch L. Route of postpartum oxytocin administration and maternal hemoglobin decline - A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2022; 272:134-138. [PMID: 35305347 DOI: 10.1016/j.ejogrb.2022.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Oxytocin uterotonic agents are routinely administered during the third stage of labor, however, the administration route is varying, intravenously or intramuscularly. We aimed to compare the effect of different regimens of postpartum oxytocin administration on hemoglobin (Hb) and hematocrit (Hct) decline. METHODS A randomized, 3-arm study of women who delivered vaginally at term in a single tertiary medical center was conducted. Immediately following the delivery of the fetus women randomly received one of 3 oxytocin regimens: 1) intramuscular 10units (IM group); 2) intravenous 10units in 100 ml 0.9%NaCl solution over 10-15 min (IV group); or 3) combined IV + IM regimens (IV + IM group). Primary outcome was defined as the level of Hb decline between prepartum and postpartum measurements. RESULTS Overall, 210 women (70 in each group) were randomized, with 171 included in the final analysis (IM group-61, IV group-57, IV + IM group-53). There was no significant difference between the groups regarding maternal age, pre-pregnancy body-mass-index (BMI), parity, operative vaginal deliveries rate, the rate of episiotomy or perineal tears or neonatal birthweight. Mean prepartum Hb and Hct level were 12.3 ± 1.1 g/dl and 36.9 ± 2.7%, respectively, with no significant difference between the groups. Mean postpartum HB and Hct decline was 1.3 ± 0.8 g/dl and 3.7 ± 2.3%, respectively, with no difference between the groups. In multivariable analysis after adjusting for parity, pre-pregnancy BMI, labor induction, episiotomy or perineal tears and neonatal birthweight, oxytocin regimen was not associated with any difference in hematological measurements. CONCLUSION Postpartum Hb and Hct decline was usually minor following vaginal deliveries, and was not affected by postpartum oxytocin regimen.
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Affiliation(s)
- Eran Ashwal
- Department of Obstetrics and Gynecology, division of Maternal-Fetal Medicine,Hamilton Health Sciences,McMaster University, Hamilton, Ontario, Canada; Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Uri Amikam
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avital Wertheimer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Emmanuel Attali
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dikla B A Dayan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Amir Aviram
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gulucu S, Uzun KE, Ozsoy AZ, Delibasi IB. Retrospective evaluation of peripartum hysterectomy patients: 8 years' experience of tertiary health care. Niger J Clin Pract 2022; 25:483-489. [PMID: 35439908 DOI: 10.4103/njcp.njcp_1722_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Peripartum hysterectomy (PPH), which means surgical removal of the uterus during pregnancy or postpartum period, is a life-saving procedure performed as a last resort to stop obstetric serious bleeding. Aim Evaluation of the prevalence, risk factors, indications, associated complications, and neonatal outcomes of PPH performed in our clinic. Patients and Methods A total of 35 patients who underwent PPH in our clinic between 2013 and 2020 were analyzed retrospectively. Clinical and demographic characteristics of patients, age, gestational week, delivery type, type of hysterectomy performed, length of hospital stay, PPH indications, additional procedures and complications during PPH, maternal and fetal mortality, neonatal characteristics, intensive care unit (ICU) need after PPH, and blood transfusion amount and time were recorded. Patients with PPH were subdivided and studied in subgroups: Emergency - elective surgery, total - subtotal hysterectomy. Results PPH was performed in 35 (3.2/1000) patients who gave birth during the study period. The most common indication for hysterectomy was placental invasion anomaly (57.1%, n = 20), and the most performed operation was total hysterectomy (68.6%, n = 24). Bilateral hypogastric artery ligation (14.3%, n = 5) was the most common alternative procedure performed before hysterectomy, and the most common complication was bladder injury (22.9%, n = 8). Blood transfusion was performed in 94.3% (n = 33) of the patients due to acute blood loss. The mean newborn weight was 2788.79 ± 913.37 g, and the 1st and 5th-minute APGAR scores were 6.71 ± 2.25 and 7.56 ± 2.35, respectively. Conclusion Before PPH, uterine integrity should be preserved using medical and surgical methods, but if success is not achieved, hysterectomy is the last life-saving step. It should be kept in mind that in patients with anemia and increased gravidity, the risk of bleeding may be high in the first 24 h after birth and therefore PPH may be required. It would be more appropriate for patients with placentation anomalies to be operated in experienced centers due to possible complications, increased blood transfusion, and intensive care requirement.
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Affiliation(s)
- S Gulucu
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
| | - K E Uzun
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
| | - A Z Ozsoy
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
| | - I B Delibasi
- Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey
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Aimagambetova G, Sakko Y, Gusmanov A, Issanov A, Ukybassova T, Bapayeva G, Marat A, Nurpeissova A, Gaipov A. The Prevalence, Incidence, Indications and Outcomes of Peripartum Hysterectomy in Kazakhstan: Data from Unified Nationwide Electronic Healthcare System 2014-2018. Int J Womens Health 2022; 14:267-278. [PMID: 35221729 PMCID: PMC8880089 DOI: 10.2147/ijwh.s343387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Peripartum hysterectomy is a surgical procedure performed as a life-saving surgery to manage severe postpartum hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. However, maternal mortality due to postpartum hemorrhage and after peripartum hysterectomy remains high in developing countries. To date, there is a lack of information about the rates of peripartum hysterectomy and its common indications in Kazakhstan. Objectives were to study the prevalence, indications, and outcomes of peripartum hysterectomy using nationwide large-scale health-care data from the national registry. PATIENTS AND METHODS We performed a descriptive, population-based study among women who underwent a peripartum hysterectomy in any health-care setting of the Republic of Kazakhstan during the period of 2014-2018. Data were collected from the Unified Nationwide Electronic Health System (UNEHS). RESULTS Data included 3838 medical records of women who had a peripartum hysterectomy performed due to specific indications for the period of 5 years (2014-2018). The median age of the participants was 33 years old, with 60.7% of women aged between 18 and 34 years. The leading indications for peripartum hysterectomy were intrapartum hemorrhage (IPH) and postpartum hemorrhage (PPH) reported in 60% of the cases analyzed. The second most common indication was placental pathology - placental abruption and placenta previa in 9.6% and 7.9% of cases, respectively. In 1633 cases (42.4%), total abdominal hysterectomy was performed, while subtotal hysterectomy was done in 2195 cases (57.0%). Based on these data, the estimated prevalence of peripartum hysterectomies was calculated: overall weighted mean prevalence 1.93 per 1000 deliveries. CONCLUSION IPH and PPH are the commonest indications for peripartum hysterectomy followed by placental pathology. Appropriate maternal care during labor and delivery should be reinforced to decrease the incidence of peripartum hysterectomy in Kazakhstan.
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Affiliation(s)
- Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Yesbolat Sakko
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Arnur Gusmanov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Alpamys Issanov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Nur-Sultan, Kazakhstan
| | - Aiymzhan Nurpeissova
- Department of Medical Information Analysis of Outpatient and Polyclinic Care, The Republican Center of Electronic Healthcare, The Ministry of Healthcare of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
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18
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Trends in Unplanned Peripartum Hysterectomy in the United States, 2009-2020. Obstet Gynecol 2022; 139:449-451. [PMID: 35115435 PMCID: PMC8857040 DOI: 10.1097/aog.0000000000004673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
The incidence of unplanned peripartum hysterectomy is increasing nationwide, which may reflect an increase in placenta accreta spectrum disorders.
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19
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Peivandi S, Peivandi S, Habibi A, Atarod Z, Moosazadeh M, Fallah S. Prevalence and Factors Associated with Peripartum Hysterectomy among Iranian Pregnant Women: A Retrospective Study. Ethiop J Health Sci 2022; 32:289-296. [PMID: 35693567 PMCID: PMC9175228 DOI: 10.4314/ejhs.v32i2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Peripartum hysterectomy (PPH) is one of the effective treatment modalities which is increasingly performed to save the life of pregnant women with uncontrollable severe postpartum hemorrhage. The aim of this study was to assess the prevalence and factors associated with PPH among Iranian pregnant women. METHODS In a retrospective study, 33 pregnant women with PPH referred to Imam Khomeini Hospital in Sari, Mazandaran province, northern Iran were enrolled. Data were collected using census sampling from March 2017 to 2020. Patients' sociodemographic and clinical characteristics were collected. Fisher's exact test, Kruskal-Wallis, and Mann-Whitney tests were used to evaluate the study variables. RESULTS The prevalence of PPH among Iranian pregnant women was 2.81 per 1000 deliveries. The mean length of stay in the hospital and intensive care unit (ICU) was 6.15 (SD=2.91) and 3.17 (SD=1.50) days, respectively. Of the participants, 90.9% had a cesarean section, 51.6% had emergency PPH, 88.2% had emergency PPH in 24 hours after delivery, 9.1% had an induction, and 60.6% had PPH due to placental abnormalities. The mean duration of PPH procedure was 2.51 (SD=1.14) hours. The most common post-operative complication in participants was fever. Participants with older gestational age had more elective PPH (P=0.029). The length of ICU stay was more in patients with total PPH procedure compared to the supracervical (P<0.017). The induction rate was higher in emergency PPH after vaginal delivery compared to cesarean section (P=0.005). CONCLUSION This study showed a high prevalence of PPH among pregnant women. Also, there was a significant relationship between the PPH and length of ICU stay, especially after supracervical hysterectomy. The results of this study can help obstetrician-gynecologist to provide a better intervention for managing patients with postpartum hemorrhage requiring PPH.
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Affiliation(s)
- Saloumeh Peivandi
- Department of Gynecology and Obstetrics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sepideh Peivandi
- Department of Gynecology and Obstetrics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Habibi
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zoleikha Atarod
- Department of Gynecology and Obstetrics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Noncommunicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Somayeh Fallah
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Lumbreras-Marquez MI, Villela-Franyutti D, Reale SC, Farber MK. Coagulation Management in Obstetric Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Emergency peripartum hysterectomy: Five-year experience in a university hospital. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.987243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Pregnancy-Related Hysterectomy for Peripartum Hemorrhage: A Literature Narrative Review of the Diagnosis, Management, and Techniques. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9958073. [PMID: 34307683 PMCID: PMC8282389 DOI: 10.1155/2021/9958073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Postpartum hemorrhage is a life-threatening situation, in which hysterectomy can be performed to prevent maternal death. However, it is associated with high rates of maternal morbidity and mortality and permanent infertility. The incidence of pregnancy-related hysterectomy varies across countries, but its main indications are the following: uterine atony and placenta spectrum (PAS) disorders. PAS disorder prevalence is rising during the last years, mainly due to the increased number of cesarean sections. As a result, obstetricians should be aware of the difficulties of this emergent condition and improve its accurate antenatal diagnosis rates, as well as its modern management strategies. Of course, special skills are required during a pregnancy-related hysterectomy, so these patients should be referred to centers of excellence in antenatal care, where a multidisciplinary team approach is followed. This study is a narrative review of the literature of the last 5 years (PubMed, Cochrane) regarding postpartum hemorrhage to offer obstetricians up-to-date knowledge on this pregnancy-related life-threatening issue. However, there is a lack of available high-quality data, because most published papers are retrospective case series or observational cohorts.
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23
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Ornaghi S, Maraschini A, Donati S. Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study. PLoS One 2021; 16:e0252654. [PMID: 34086797 PMCID: PMC8177430 DOI: 10.1371/journal.pone.0252654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/19/2021] [Indexed: 01/06/2023] Open
Abstract
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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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Foundation MBBM at San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
- * E-mail:
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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Donati S, Buoncristiano M, Lega I, D’Aloja P, Maraschini A. The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths. PLoS One 2021; 16:e0250373. [PMID: 33891629 PMCID: PMC8064507 DOI: 10.1371/journal.pone.0250373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS's vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007-2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014-2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
- * E-mail:
| | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - for the ItOSS working group
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
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Chaudhary V, Singh M, Nain S, Reena F, Aggarwal K, Biswas R, Puri M, Pujari J. Incidence, Management and Outcomes in Women Undergoing Peripartum Hysterectomy in a Tertiary Care Centre in India. Cureus 2021; 13:e14171. [PMID: 33936882 PMCID: PMC8080949 DOI: 10.7759/cureus.14171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 01/28/2023] Open
Abstract
Background Peripartum hysterectomy (PRH) is the surgical removal of the uterus performed in obstetrical complications such as uncontrolled postpartum haemorrhage (PPH), unrepairable uterine rupture, and sepsis. Its incidence has increased in recent years. The objective of this study was to review all the cases of PRH in a tertiary care teaching hospital over three years (January 2017-December 2019) to determine its incidence and analyse clinico-demographic characteristics in these women. Method All women undergoing PRH from January 2017 to December 2019 were included in the study. Data were collected retrospectively from medical records, of patients who underwent a PRH at the time of delivery, or within 24 hours, or performed any time before discharge from the same hospitalization and obstetric event. The total number of deliveries including caesarean and vaginal deliveries were recorded. Main outcome measures were the incidence of PRH, indication for hysterectomy, management option used, maternal outcomes (PPH, bladder injury and maternal death) and fetal outcomes (stillbirth). Results There were a total of 3904,4 deliveries; 27,337 vaginal and 11,697 caesarean sections in three years. A total of 50 patients underwent a PRH. The incidence of PRH in our study was 1.3 per 1,000 deliveries and 3.5/1,000 caesareans, respectively. PRH was found to be more common following cesarean sections than vaginal deliveries (odds ratio 22.86 [95% CI: 8.16 to 63.98]). Morbid adherent placenta (MAP) (n=30, 62%) was the most common indications of PRH. Seven (15%) women had PRH due to uterine rupture. Twenty-seven women of the 30 women (90%) with the MAP had a previous caesarean delivery. The case fatality rate per hysterectomy was 4%. Stillbirth rate (SBR: n=8,16%) among women having PRH was seven-fold higher than overall SBR in our country. Conclusion There has been a rise in MAP as an indication of PRH in our study for a decade in comparison to uterine atony. Caesarean delivery is a significant risk factor for PRH. Previous caesarean section and major placenta previa were common occurring obstetric risk factors present in the MAP in our cohort. Our maternal mortality in PRH was low and the stillbirth rate was high when compared with national data.
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Affiliation(s)
- Vidhi Chaudhary
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Meenakshi Singh
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Shilpi Nain
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Fnu Reena
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Kiran Aggarwal
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Ratna Biswas
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Manju Puri
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
| | - Janithya Pujari
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, IND
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Kallianidis AF, Maraschini A, Danis J, Colmorn LB, Deneux-Tharaux C, Donati S, Gissler M, Jakobsson M, Knight M, Kristufkova A, Lindqvist PG, Vandenberghe G, van den Akker T. Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries. Acta Obstet Gynecol Scand 2021; 100:1345-1354. [PMID: 33719032 PMCID: PMC8360099 DOI: 10.1111/aogs.14113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/20/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
Introduction Peripartum hysterectomy is applied as a surgical intervention of last resort for major obstetric hemorrhage. It is performed in an emergency setting except for women with a strong suspicion of placenta accreta spectrum (PAS), where it may be anticipated before cesarean section. The aim of this study was to compare management strategies in the case of obstetric hemorrhage leading to hysterectomy, between nine European countries participating in the International Network of Obstetric Survey Systems (INOSS), and to describe pooled maternal and neonatal outcomes following peripartum hysterectomy. Material and methods We merged data from nine nationwide or multi‐regional obstetric surveillance studies performed in Belgium, Denmark, Finland, France, Italy, the Netherlands, Slovakia, Sweden and the UK collected between 2004 and 2016. Hysterectomies performed from 22 gestational weeks up to 48 h postpartum due to obstetric hemorrhage were included. Stratifying women with and without PAS, procedures performed in the management of obstetric hemorrhage prior to hysterectomy between countries were counted and compared. Prevalence of maternal mortality, complications after hysterectomy and neonatal adverse events (stillbirth or neonatal mortality) were calculated. Results A total of 1302 women with peripartum hysterectomy were included. In women without PAS who had major obstetric hemorrhage leading to hysterectomy, uterotonics administration was lowest in Slovakia (48/73, 66%) and highest in Denmark (25/27, 93%), intrauterine balloon use was lowest in Slovakia (1/72, 1%) and highest in Denmark (11/27, 41%), and interventional radiology varied between 0/27 in Denmark and Slovakia to 11/59 (79%) in Belgium. In women with PAS, uterotonics administration was lowest in Finland (5/16, 31%) and highest in the UK (84/103, 82%), intrauterine balloon use varied between 0/14 in Belgium and Slovakia to 29/103 (28%) in the UK. Interventional radiology was lowest in Denmark (0/16) and highest in Finland (9/15, 60%). Maternal mortality occurred in 14/1226 (1%), the most common complications were hematologic (95/1202, 8%) and respiratory (81/1101, 7%). Adverse neonatal events were observed in 79/1259 (6%) births. Conclusions Management of obstetric hemorrhage in women who eventually underwent peripartum hysterectomy varied greatly between these nine European countries. This potentially life‐saving procedure is associated with substantial adverse maternal and neonatal outcome.
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Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Jakub Danis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lotte B Colmorn
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cite, Inserm U1153, Paris Descartes University, Paris, France
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää Hospital HUCH, University of Helsinki, Helsinki, Finland
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pelle G Lindqvist
- Clinical Science and Education, Karolinska Institute, Department of Obstetrics and Gynecology, Sodersjukhuset Hospital, Stockholm, Sweden
| | - Griet Vandenberghe
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Athena Institute, VU, Amsterdam, the Netherlands
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Kallianidis AF, Maraschini A, Danis J, Colmorn LB, Deneux-Tharaux C, Donati S, Gissler M, Jakobsson M, Knight M, Kristufkova A, Lindqvist PG, Vandenberghe G, Van Den Akker T. Epidemiological analysis of peripartum hysterectomy across nine European countries. Acta Obstet Gynecol Scand 2020; 99:1364-1373. [PMID: 32358968 PMCID: PMC7540498 DOI: 10.1111/aogs.13892] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries. MATERIAL AND METHODS We performed a descriptive, multinational, population-based study among women who underwent peripartum hysterectomy. Data were collected from national or multiregional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48 hours postpartum for obstetric hemorrhage, as this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section. RESULTS A total of 1302 peripartum hysterectomies were performed in 2 498 013 births, leading to a prevalence of 5.2 per 10 000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared with vaginal birth was 9.1 (95% CI 8.0-10.4). Relative risk for hysterectomy for birth after previous cesarean section compared with birth without previous cesarean section was 10.6 (95% CI 9.4-12.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (ρ = 0.67, P < .05). CONCLUSIONS Prevalence of peripartum hysterectomy may vary considerably between high-income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine-fold increased risk of peripartum hysterectomy.
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Affiliation(s)
- Athanasios F Kallianidis
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Jakub Danis
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lotte B Colmorn
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cite, Paris University, Paris, France
| | - Serena Donati
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, Hyvinkää hospital HUCH, University of Helsinki, Helsinki, Finland
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Pelle G Lindqvist
- Clinical Science and Education, Department of Obstetrics and Gynecology, Karolinska Institute, Sodersjukhuset Hospital, Stockholm, Sweden
| | - Griet Vandenberghe
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Van Den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Athena Institute, VU University Amsterdam, The Netherlands
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