Emergency obstetric hysterectomy in a university hospital: A 25-year review

Jamal, Rahman; Alali, Mohammed; Qutub, Hatem; Al-Suleiman, S S; Al-Jama, Fathia E.; Rahman, Mohammad Maksudur

doi:10.1080/01443610701816885

Cited by 68 publications

(51 citation statements)

References 14 publications

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“…In United Kingdom it is 0.41/ 1000 births 7 , Denmark it is 0.24/1000 births 9 , in Saudi Arabia it is 0.64/1000 10 , in Korle Bu Ghana it is 4.34/1000 2 , Nigeria 5.4/1000 1 and Durban in South Africa 5.1/1000. 3 The differences have been attributed to the different levels of obstetric care offered.…”

Section: Introductionmentioning

confidence: 99%

Peripartum hysterectomy: Two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa

Wandabwa¹,

Businge²,

Longo-Mbenza³

et al. 2013

Afr H. Sci.

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Background: Obstetric haemorrhage is the leading direct cause of maternal mortality in South Africa. Objective: To determine the incidence, indications, associations and maternal outcomes of emergency peripartum hysterectomies. Methods: A descriptive and retrospective analysis of patients who had peripartum hysterectomy between 1 st February 2007 and 31 st January 2009 in Nelson Mandela Academic Hospital at Mthatha city. Results: The incidence of 0.95% of peripartum hysterectomies (n=63 or 9.5/1000 births) increased with the increasing maternal age from 0.121% at age of less than 20 years to 0.5% at age more or equal to 30 years. Similarly the incidence increased with parity from 0.332% for Primiparity to 0.468% at parity of four or more. The indications for the operation were uterine atony 19/63 (30.2%), secondary haemorrhage/puerperal sepsis 17/63 (27%) and ruptured uterus 16/63 (23.4%). The main intra operative complication was haemorrhage 13/63 (20.6%). Repeat laparotomy was done in 10/63 (15%) of patients due to haemorrhage. Admission to intensive care unit was 25/63 (39.7%). The case specific mortality rate was of 19 % (n=12). The main causes of death were hypovolaemic shock and septicemia. Conclusion: The incidence of peripartum hysterectomies was high and was associated with ruptured uterus and puerperal sepsis which are preventable.

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Section: Introductionmentioning

confidence: 99%

Peripartum hysterectomy: Two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa

Wandabwa¹,

Businge²,

Longo-Mbenza³

et al. 2013

Afr H. Sci.

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“…5,8,[10][11][12][13][14][15][16][17][18] Early diagnosis and evidence-based treatment of cesarean scar pregnancies may avoid lifethreatening obstetric complications.…”

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confidence: 99%

Cesarean Scar Pregnancies

Timor‐Tritsch

Khatib

Monteagudo

et al. 2015

J of Ultrasound Medicine

133

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Objectives To evaluate the management, clinical courses, and outcomes of cesarean scar pregnancies diagnosed in the first trimester. Methods We identified 60 cases of cesarean scar pregnancies diagnosed between 5 and 14 weeks. Group A contained 48 patients with fetal/embryonic cardiac activity; group B comprised 12 patients without cardiac activity; and group C included 11 patients with cardiac activity who chose expectant management. Results Five of the 48 patients (10.4%) in group A were successfully treated for vaginal bleeding. Thirty‐three (68.7%) received methotrexate injections, and all had full resolution. Three (6.3%) required uterine artery embolization for late‐developing arteriovenous malformations. Ten of the 12 patients (83.3%) in group B were managed expectantly and had full recovery. Two of the 10 (20.0%) had arteriovenous malformations; 1 had unsuccessful uterine artery embolization followed by a hysterectomy, and the second requested a hysterectomy. Ten of the 11 patients (90.9%) in group C continued the pregnancies. One declined local injection. Four of the 10 (40.0%) delivered live offspring by successive elective cesarean deliveries. Three (30.0%) had hysterectomies for placenta percreta, and 1 did not have a hysterectomy after delivery. Five (50%) had second‐trimester complications, all leading to hysterectomies. Of the 60 patients, 20 (33.3%) had serious complications: 5 had arteriovenous malformations; 4 had uterine artery embolization; and 11 had hysterectomies. Conclusions A cesarean scar pregnancy is a serious complication for patients who have had cesarean deliveries. Counseling, treatment, and follow‐up are challenging for patients and caregivers. However, emerging data from different management approaches confirm that a cesarean scar pregnancy may progress and result in a live neonate at the expense of further fertility. This study confirmed that expectant management of a cesarean scar pregnancy is associated with a high risk of hysterectomy due to morbidly adherent placenta.

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“…Relatively lower percentages of STAH have been reported in other studies elsewhere (Kastner et al 2002;Ezechi, et al, 2004;Selo-Ojeme et al, 2005;Ozden et al, 2005;Rahman et al, 2008). The decision to do total or subtotal emergency hysterectomy depends on the experience of the surgeon performing the operation and the condition of the patient.…”

Section: Discussionmentioning

confidence: 87%

Emergency peripartum hysterectomies at Muhimbili National Hospital, Tanzania: Review of cases from 2003 to 2007

Pembe

Wangwe

Massawe

2012

Tanzania J Hlth Res

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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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Emergency obstetric hysterectomy in a university hospital: A 25-year review

Cited by 68 publications

References 14 publications

Peripartum hysterectomy: Two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa

Peripartum hysterectomy: Two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa

Cesarean Scar Pregnancies

Emergency peripartum hysterectomies at Muhimbili National Hospital, Tanzania: Review of cases from 2003 to 2007

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