Emergency Peripartum Hysterectomy: A 9-Year Review

Department of Obstetrics and Gynecology, Duzce School of Medicine, Abant Izzet Baysal University, 81620, Konuralp, Duzce, Turkey.
Archives of Gynecology and Obstetrics (Impact Factor: 1.36). 06/2006; 274(2):84-7. DOI: 10.1007/s00404-006-0124-4
Source: PubMed


To determine the incidence, indications, risk factors, and complications of emergency peripartum hysterectomy.
A retrospective study of the patients requiring an emergency peripartum hysterectomy of a 9-year period was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 h after delivery. Demographic and clinical variables were obtained from the maternal records.
There were 34 emergency peripartum hysterectomies out of 117,095 deliveries for a rate of 0.29 per 1,000. Of the 16 cases that were delivered by cesarean section, seven had a previous cesarean section and 18 cases were delivered vaginally, including two using vacuum extraction. Total hysterectomy was performed in 24 patients, and subtotal hysterectomy in ten patients. The indications for hysterectomy were uterine rupture (n=12), placenta accreta (n=10), uterine atony (n=7), and hemorrhage (n=5). There were two maternal deaths, six stillbirths, and two early neonatal deaths.
This study identified surgical deliveries, uterine rupture, placenta accreta, and uterine atony as risk factors for emergency peripartum hysterectomy. The most common reason for abnormal placental adherence was a previous cesarean section. Multiparity and oxytocin use for uterine stimulation were among the risk factors for uterine atony that necessitated emergency peripartum hysterectomy.

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    • "Cesarean delivery is the major risk factor for peripartum hysterectomy and due to recently raising cesarean delivery rate and the increasing population with a scarred uterus, the incidence of emergency peripartum hysterectomy may indirectly increase. Historically, the most common indication cited for peripartum hysterectomy was uterine atony[456789] but, more recent reports have suggested that abnormal placentation, including placenta accreta, has become the most common indication for peripartum hysterectomy.[1011] "
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    ABSTRACT: Peripartum hysterectomy is associated with significant morbidity and mortality. We determined the factors leading to and maternal mortality and morbidity rates among the women whose underwent peripartum hysterectomy in Iran. This case-series study was conducted from March 2004 to March 2009 in the Department of Gynecology and Obstetrics at two central university hospitals (Azahra hospital and Shahid Beheshti Hospital) in Isfahan. Forty one women among 29,444 deliveries underwent peripartum hysterectomy. Women who had delivery before 24 weeks and a hysterectomy for other reasons like sterilizations were excluded. Incidence, indications and maternal complications including maternal death and urological, infectious and wound complications were evaluated after operation. During the study period, the incidence of peripartum hysterectomy estimated about 1.39 per 1,000 deliveries. The maternal mortality rate was 17.07%. There was no statistical difference in mortality rates between referrals and non-referrals women (P = 0.6). Post-operative complications included infection (22%), bladder injuries (7.3%), urine retention (4.8%) and wound dehiscence (4.87%). The main indication was placenta accreta 28 (68.3%). This study indicated the high rate of mortality among patients underwent peripartum hysterectomy. Evaluation of management during referring the patients and designing more studies to evaluate the mortality and morbidities are warranted.
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    • "It is therefore unplanned and must be performed expeditiously usually in patients that are generally in less than ideal condition to withstand anesthesia and trauma of surgery. It has been described as one of the riskiest and most dramatic operations in modern obstetrics[2] [4] [5]. It is therefore associated with significant maternal morbidity and mortality. "

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    • "Total hysterectomy is recommended in cases of placenta attached to the lower segment as the whole uterus needs to be removed to stop the bleeding (Murta et al., 1993). Another reason put forward is the potential risks for cervical stump to develop malignancy thus needing regular cytology screening and other problems which may occur such as bleeding or abnormal vaginal discharge (Yucel et al., 2006). "
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    ABSTRACT: A retrospective review of all cases of emergency peripartum hysterectomy performed between January 1, 2003 and December 31, 2007 at Muhimbili National Hospital was done to determine the incidence, indications and complications, background characteristics, antenatal care attendance, referral status, and maternal and foetal outcomes. There were 55,152 deliveries during the study period and 165 cases of emergency peripartum hysterectomy, giving the incidence of emergency peripartum hysterectomy of 3 per 1000 deliveries. The main indication was uterine rupture (79%) followed by severe post-partum haemorrhage due to uterine atony (12.7%). The case fatality rate was 10.3% where as perinatal mortality rate was 7.7 per 1000 deliveries. The common complication identified intraoperatively was severe haemorrhage which accounted for 39.4% where as intensive care unit admissions (14.4%) and febrile morbidity (12.4%) were common after the operation. Blood was ordered in all cases but in 31 cases it was indicated that it was not available. Seventy nine patients received blood transfusion with the maximum number of units given to one patient being eight. Twenty two patients were given fresh frozen plasma (FFP), the median number of units given was two (range = 1– 6). In conclusion, emergency peripartum hysterectomy is a life saving procedure and very common at MNH. The most common indication was ruptured uterus followed by severe postpartum haemorrhage. More than half of the patients underwent emergency peripartum hysterectomy were referred from other health facilities with ruptured or suspected ruptured uterus. The procedure was associated with unacceptably high maternal and perinatal morbidity and mortality.
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