Emergency peripartum hysterectomy in a tertiary Istanbul hospital

Kayabasoglu, Furkan; Güzin, Kadir; Aydogdu, Serkan; Sezginsoy, Selen; Turkgeldi, Lale; Gunduz, Gunes

doi:10.1007/s00404-007-0551-x

Cited by 43 publications

(42 citation statements)

References 23 publications

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“…Una segunda cirugía, después de la HPP debido a hemoperitoneo o hemorragia retroperitoneal, se describe hasta en el 6% de las pacientes, muchas veces asociada a coagulopatía de consumo (24). En esta serie, 2 pacientes (5,8%) requirieron de una reintervención quirúrgica, una de ellas en 4 oportunidades.…”

Section: Discussionunclassified

“…La implicancia sobre la fertilidad de la mujer puede ser la causa de una posible depresión (24). En esta serie se registró un 5,8% de depresión durante el posoperatorio tardío.…”

Section: Discussionunclassified

“…El tratamiento de estas complicaciones y según la causa que la ocasiona incluye el uso de medicamentos uterotónicos, masaje uterino, balones y/o taponaje intrauterino, embolización de las arterias uterinas, ligadura de vasos sanguíneos, suturas compresivas (B-Lynch) e histerectomía en aquellos casos que no responden a ninguna de las medidas anteriores. La literatura médica estima una incidencia de HPP entre 0,29 y 3,78 por cada 1000 partos (6)(7)(8)(9)(10)(11). El 10% de ellas puede requerir una segunda intervención (12).…”

Section: Introductionunclassified

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Histerectomía Posparto: Experiencia De Clínica Las Condes

et al. 2010

Rev. chil. obstet. ginecol.

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Section: Discussionunclassified

“…La implicancia sobre la fertilidad de la mujer puede ser la causa de una posible depresión (24). En esta serie se registró un 5,8% de depresión durante el posoperatorio tardío.…”

Section: Discussionunclassified

Section: Introductionunclassified

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Histerectomía Posparto: Experiencia De Clínica Las Condes

et al. 2010

Rev. chil. obstet. ginecol.

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“…Other factors that have been associated with EPH include advanced maternal age, multiparity, multiple gestations, and gestational diabetes. [2,[12][13][14][15][16] Conservative treatment of postpartum hemorrhage includes uterotonics (oxytocin, ergotamine), uterine massage, uterine artery embolization, uterine packing, pelvic vessel ligation, B-Lynch suture, multiple square sutures, and recombinant-activated factor VII [17]. The most severe complication of hemorrhage is maternal death, whose risk is estimated to be approximately 1 in 100,000 deliveries in developed countries and has been increasing.…”

Section: Introductionmentioning

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Emergency Peripartum Hysterectomy: A 10-Year Review

Carvalho

Cubal

Torres

et al. 2012

ISRN Emergency Medicine

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Background. Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Purpose. To determine the incidence, risk factors, indications, outcomes, and complications of EPH performed in a tertiary teaching hospital and to compare the results with other reports in the literature. Methods. The medical records of 13 patients who had undergone EPH, between January 2000 and December 2010, were reviewed retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results. There were 13 EPHs out of 31.767 deliveries, a rate of 0.41 per 1,000 deliveries. Eight hysterectomies were performed after cesarean delivery and five after vaginal delivery. The most common indication for hysterectomy was uterine atony (10/13), followed by placenta previa (2/13). There were one case of intraoperative bladder injury and one case of relaparotomy because of hemoperitoneum. We had one maternal death because of septic shock. There were no cases of neonatal morbidity and mortality. Conclusion. Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face. IntroductionEmergency peripartum hysterectomy (EPH) is an uncommon obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. [1][2][3] It was first proposed in 1869 but with no desirable results [4]. However, seven years later (1876), the first cesarean subtotal hysterectomy was carried out successfully, with the result that both the mother and the baby survived [5]. In modern obstetrics, the overall incidence of EPH is 0.05%, but there are considerable differences in incidence in different parts of the world, depending on modern obstetric services, standards and awareness of antenatal care, and the effectiveness of family planning activities of a given community [6]. The incidence of peripartum hysterectomy in the literature is reported as 0.24, 0.77, 2.3, and 5.09 per 1,000 deliveries by Sakse et al. [7], Whiteman et al. [8], Bai et al. [9] and Zeteroglu et al. [10], respectively. However, there is a lack of Portuguese data on EPH. To our knowledge, there is no Portuguese information on EPH.Severe postpartum hemorrhage was reported to occur in 6.7/1,000 deliveries worldwide. It is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face [11]. The main causes of the uncontrollable hemorrhage necessitating an EPH have changed since the 1980s [2]. Uterine atony and rupture have been overtaken by abnormal placentation in many studies. This is not only because of improved conservative management of uterine atony and a reduced incidence of uterine rupture due to the extensive use of the lower uterine segment inci...

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“…[5][6][7][8]11,12,22,24,25] In middle-income countries the aetiology is variable, with studies from Turkey, India and Thailand showing similar indications to high-resource settings but with higher rates of uterine rupture. [4,15,16,21,[26][27][28] Sepsis has been reported as an indication in low-resource settings. In Africa the most common aetiologies include uterine rupture, atonic uteri and sepsis.…”

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Sepsis: Primary indication for peripartum hysterectomies in a South African setting

Vuuren

Cluver

2016

S Afr J OG

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Background. Peripartum hysterectomies are lifesaving procedures but definitions vary. Indications are variable and dependant on resources and geographical factors. Objectives. To evaluate the incidence, aetiology and complications associated with peripartum hysterectomies in a tertiary hospital in South Africa. Methods. A retrospective audit at an academic referral centre over a 5-year period from February 2009 to March 2014 was performed.Procedures from a gestation of 24 weeks until 6 weeks postpartum were included. Results. One hundred and sixty cases met inclusion criteria. Nine case records were unavailable. The incidence was 2.77 per 1 000 deliveries. Main indications were sepsis (60, 39.7%), atony (24, 15.9%), morbidly adherent placenta (21, 13.9%), tears (14, 9.3%), uterine rupture (8, 5.3%), placenta praevia (7, 4.6%) and unclassified bleeding (6, 4.0%). There were 6 maternal deaths. Five related to sepsis and one to hypovolaemic shock. One hundred and thirty-eight (91.4%) women required high or intensive care admission. Conclusion. Sepsis is an important aetiology for peripartum hysterectomies, particularly in southern Africa. The high rate of sepsis may be due to HIV infection, low socioeconomic standards, late diagnosis, limited access to healthcare, sterility issues and differences in the definition and inclusion criteria used for a peripartum hysterectomy. A peripartum hysterectomy is a lifesaving procedure usually performed as an emergency that can be associated with significant morbidity and mortality.[1] Despite many publications, the definition of a peripartum hysterectomy remains vague. Definitions include a hysterectomy performed within 24 hours of delivery, [2][3][4][5] a hysterectomy performed within the same hospitalisation, [6][7][8][9][10] a hysterectomy performed within 72 hours of delivery, [11] a hysterectomy performed within 1 month of delivery [12,13] to a hysterectomy performed within 6 weeks of delivery. [14] Some even limit the definition to a hysterectomy performed for uncontrolled haemorrhage only [4,[15][16][17][18][19][20][21][22] and exclude cases of infection.[12] The varying definitions make it difficult to compare incidences and aetiology. If a short time period after delivery is used, complications related to sepsis and delayed haemorrhage may be underestimated.Peripartum hysterectomies complicate about 1 in 1 000 pregnancies.[23] The incidence is lower in higher-resource settings. In a large review from the USA the incidence was 0.77 per 1 000 deliveries [10] while African countries have reported higher incidences ranging from 4.34 to 9.5 per 1 000 deliveries. [9,14,17,19] Lack of antenatal and peripartum care due to limited resources, a high burden of HIV infection and a delay in recognising complications may be reasons for the higher incidences.In high-resource settings complications of placentation are the most common indication for hysterectomy. [5][6][7][8]11,12,22,24,25] In middle-income countries the aetiology is variable, with studies from Turkey, India and Thail...

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Emergency peripartum hysterectomy in a tertiary Istanbul hospital

Abstract: Peripartum hysterectomy is still a dramatic life-saving operation with high risks. The most common reason for abnormal placental adherence is previous uterine procedures.

Cited by 43 publications

References 23 publications

Histerectomía Posparto: Experiencia De Clínica Las Condes

Histerectomía Posparto: Experiencia De Clínica Las Condes

Emergency Peripartum Hysterectomy: A 10-Year Review

Sepsis: Primary indication for peripartum hysterectomies in a South African setting

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