Emergency peripartum hysterectomy in the nulliparous patient

Seffah, J.D.; Kwame-Aryee, RA

doi:10.1016/j.ijgo.2006.11.018

Cited by 4 publications

(4 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our EPH incidence of 0.39 per 1,000 deliveries compares favourably with those quoted from developed countries [2,3,4,5,6]. Much higher rates of 2.7 per 1,000 deliveries have been reported from developing countries [7,8,9,10]. The cutoff point at which hysterectomy becomes necessary is subjective and ill-defined.…”

Section: Discussionsupporting

confidence: 61%

“…The incidence of EPH varies from 0.3 to 1.6 per 1,000 deliveries in developed countries [2,3,4,5,6] and may be higher in developing countries [7,8]. The purpose of this preliminary study in Kuwait was to estimate the incidence, indications, risk factors and complications associated with EPH performed in a tertiary teaching hospital in Kuwait.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A 26-Year Review of Emergency Peripartum Hysterectomy in a Tertiary Teaching Hospital in Kuwait – Years 1983–2011

et al. 2011

View full text Add to dashboard Cite

Objective: To identify the risk factors and study the incidence, indications and complications of emergency peripartum hysterectomy (EPH). Materials and Methods: This was a retrospective case-control study. The cases consisted of all women who underwent EPH between January 1983 and January 2011. Two controls per case were randomly selected from the remaining deliveries by using a random number table. Case records were retrieved from the medical records. Results: Among 150,993 deliveries, there were 59 EPHs (cases), giving a rate of 0.390 per 1,000. Of the 59 cases, only 56 were analysed because 3 files were unavailable. These women were older (mean age 36 ± 5.7 vs. 22 ± 5.3 years, p < 0.01) and had delivered more than 1 child (p = 0.02). Thirty-seven (66%) cases had had previous caesarean sections (CSs) and the number of CSs in this group was greater than in the controls (21%, p < 0.01). More index cases had a history of atonic postpartum haemorrhage (46 vs. 4%, p < 0.001) and placenta praevia (34 vs. 4%, p < 0.01). More cases than controls were delivered by CS (73 vs. 29%; p = 0.003). The leading indications for EPH were haemorrhage due to uterine atony and placenta praevia. Independent risk factors were older age, multiparity, history of one or more CSs and placenta praevia. There were 2 maternal deaths from coagulopathy following massive obstetric haemorrhage. The main complications of EPH were febrile morbidity: 12 (21%), wound infection: 8 (14%) and bladder or ureteric injury: 8 (14%). Conclusions: CSs, especially repeat CSs in women with placenta praevia and persistent uterine atony, significantly increased the risks of peripartum hysterectomy.

show abstract

Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

A 26-Year Review of Emergency Peripartum Hysterectomy in a Tertiary Teaching Hospital in Kuwait – Years 1983–2011

et al. 2011

View full text Add to dashboard Cite

show abstract

“…One patient died due to hemorrhagic shock from a ruptured uterus, and 3 patients died due to sepsis after being referred from periphery of the city after obstructed labor. Compared to a study in Ghana, “there were no maternal deaths but there were 7 near-missed fatalities”; whereas a study in Maryland noted 2 deaths in 34 patients from 1991 to 2001 [4, 5]. A study done at another tertiary care facility in another city of Pakistan noted maternal mortality in 4 (19%) of their cases [6].…”

Section: Resultsmentioning

confidence: 99%

Experience of Emergency Peripartum Hysterectomies at a Tertiary Care Hospital in Quetta, Pakistan

Fatima

Kasi

Baloch

et al. 2011

ISRN Obstetrics and Gynecology

View full text Add to dashboard Cite

Emergency peripartum hysterectomy (EPH) is associated with significant morbidity and mortality worldwide. The purpose of our paper was to determine the incidence, morbidity, and mortality of EPH done at our institution; the largest tertiary care government hospital in the city of Quetta, Pakistan. During the study period there were 12,642 deliveries, out of which 46 women had undergone an EPH, translating into an incidence of ∼4 per 1,000 births. Disturbingly, 82.6% of these patients had received no antenatal care prior to their presentation. There were 4 (8.7%) maternal deaths and 31 (67.4%) perinatal deaths. The commonest indication noted was uterine rupture in 21 (45.7%) cases. Lack of antenatal care is indeed a modifiable factor that needs to be addressed to help reduce maternal and fetal morbidity/mortality not only from emergency hysterectomies but also from all other preventable causes.

show abstract

“…In Africa the most common aetiologies include uterine rupture, atonic uteri and sepsis. [14,19,[29][30][31] Three studies performed in tertiary care settings in South Africa (SA) have shown particularly high rates of sepsis. A study performed in Mthatha showed that uterine atony, puerperal sepsis and secondary postpartum haemorrhage made up 57% of the indications.…”

mentioning

confidence: 99%

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

Vuuren

Cluver

2016

S Afr J OG

View full text Add to dashboard Cite

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...

show abstract

Emergency peripartum hysterectomy in the nulliparous patient

Abstract: Though rare, peripartum hysterectomy in the nulliparous patients carries high maternal morbidity and perinatal mortality.

Cited by 4 publications

References 3 publications

A 26-Year Review of Emergency Peripartum Hysterectomy in a Tertiary Teaching Hospital in Kuwait – Years 1983–2011

A 26-Year Review of Emergency Peripartum Hysterectomy in a Tertiary Teaching Hospital in Kuwait – Years 1983–2011

Experience of Emergency Peripartum Hysterectomies at a Tertiary Care Hospital in Quetta, Pakistan

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

Contact Info

Product

Resources

About