Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide

Kallianidis, Athanasios F.; Rijntjes, Douwe; Brobbel, Carolien; Dekkers, Olaf M.; Bloemenkamp, Kitty W. M.; Akker, Thomas van den

doi:10.1097/aog.0000000000005022

Cited by 11 publications

(6 citation statements)

References 121 publications

(324 reference statements)

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“…5 While participants described feeling upset about a patient's death or a resulting complication, exploration of the SVE revealed a number of potentially triggering factors, including shared characteristics with the patient or family, situations involving moral distress, medical error, litigation, and long periods of time caring for the patient. Healthcare professionals in OB/GYN and Pediatric specialties are especially vulnerable due to exposure to events such as emergent peripartum hysterectomy or other complications that impact a patient's future fertility, fetal/neonatal loss, young patient-related death or injury, and maternal death 22–25 ; similar events were reported by our participants as prompting their SVE. Broader cultural factors, such as the routinization of pregnancy and exceptionalism of child morbidity and mortality, may also be influential in how HCPs experience the adverse event.…”

Section: Discussionsupporting

confidence: 65%

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Factors influencing second victim experiences and support needs of OB/GYN and pediatric healthcare professionals after adverse patient events

Rivera-Chiauzzi,

Riggan,

Huang

et al. 2023

Journal of Patient Safety and Risk Management

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There is growing recognition that clinical and nonclinical healthcare professionals may become “second victims” following adverse patient events, medical errors, or patient-related injuries. In addition to the trauma-associated symptoms experienced by second victims, unprocessed second victim experience (SVE) can lead to burnout and leaving the healthcare workforce. To better understand the risk factors and support needs of affected healthcare professionals after a SVE, we conducted in-depth qualitative interviews with twelve staff in obstetrics & gynecology and pediatrics at a large academic medical institution in the upper Midwest of the U.S. Several participants indicated that it was not the patient outcome itself that precipitated the SVE, but associated factors such as moral distress or communication challenges. Participants discussed the role of their work unit culture in post-SVE processing, expressing that units perceived as blame-seeking or where adverse events were not openly discussed, hindered their recovery. While desired support mechanisms were individualized, participants stressed the importance of immediate and proactive support, such as through a peer support program, and long-term support mechanisms for lingering symptoms. As attrition of the healthcare workforce continues to be a significant concern, it is essential that we understand and meet the post-SVE support needs of affected staff, to promote holistic care following adverse patient events.

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Section: Discussionsupporting

confidence: 65%

“…Bolstering emotional support services may reduce provider burnout and facilitate improved workforce retention via holistic care. 22,29 Support should also be provided outside of reporting structures, to mitigate concerns related to performance review.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing second victim experiences and support needs of OB/GYN and pediatric healthcare professionals after adverse patient events

Rivera-Chiauzzi,

Riggan,

Huang

et al. 2023

Journal of Patient Safety and Risk Management

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“…9,11 A large number of studies, from international authors, depict a much lower incidence of similar cases as they are much more developed than India. [14][15]18,19 In a similar study from our institution, 5 years ago, the incidence was 1/1000 deliveries by Varalakshmi which implies that rate of peripartum hysterectomy has increased over time due to increase in LSCS rates which leads to increase in cases of morbidly adherent placenta and rupture of uterus. 16 The rate of peripartum hysterectomy has risen because of increase in rate of LSCS.…”

Section: Discussionmentioning

confidence: 72%

A retrospective study on epidemiology and outcomes of peripartum hysterectomy

Gupta,

Maurya,

Bhandari

et al. 2024

Int J Reprod Contracept Obstet Gynecol

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Background: Peripartum hysterectomy is a rare condition which is associated with maternal morbidity and mortality, and the last resort to control hemorrhage when all the other methods fail. The main aim of this study was to evaluate the indications, incidence and complications, maternal and perinatal outcome and compare the risk of peripartum hysterectomy in women who underwent LSCS previously with the women who did not have previous LSCS. Methods: A retrospective study was done over one year at a tertiary care teaching hospital in southern Rajasthan. All the women who underwent peripartum hysterectomy were included. Patients were divided into two groups, one who did not have any previous lower segment caesarean section (LSCS) and other who had history of previous LSCS, and their data was compared. The, results were calculated and represented as mean, frequency or median as appropriate. Results: 34 women underwent peripartum hysterectomy yielding the incidence of 2.21/ 1000 deliveries. The main indication of peripartum hysterectomy was abnormally adherent placenta followed by rupture uterus. 73% cases of peripartum hysterectomy were associated was the history of LSCS. Conclusions: The indication of peripartum hysterectomy has changed from atonic PPH to placenta spectrum syndrome. A major change can be brought about by the reduction of index cases of LSCS which has been on the rise in the recent years. Strict protocols should be made. Early transportation facility and institutional deliveries should be promoted to prevent the emergency peripartum hysterectomy.

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“…Defined by the World Health Organization [3] as a near-miss event, this intervention is primarily performed to control lifethreating obstetric hemorrhage, uterine rupture, abnormally invasive placenta, or sepsis [4][5][6]. While a peripartum hysterectomy can be lifesaving, it is associated with morbidity (further blood loss, infection) and mortality [7][8][9]. Peripartum hysterectomy is an important obstetric surveillance measure as it is frequently used in combination with postpartum hemorrhage (PPH) as an indicator of severe PPH.…”

Section: Introductionmentioning

confidence: 99%

“…In the event of severe PPH, peripartum hysterectomy is indicated when conservative treatments to control bleeding have failed, such as medical (i.e., uterotonic or antifibrinolytic agents, tamponade techniques, uterine artery embolization) or surgical management (i.e., vascular ligation, uterine compression sutures) [4,10]. There are three main surgical approaches for peripartum hysterectomy: abdominal (most common), vaginal, or laparoscopic [7]. In the US, the rate of hysterectomy increased from 0.87 to 1.28 per 1,000 deliveries between 2008 and 2021 [2].…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in peripartum hysterectomy among individuals with a previous cesarean delivery by race/ethnicity in the United States: A population-based cohort study

Rajasingham,

Hossein Pour,

Scattolon

et al. 2024

PLoS ONE

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Objectives Rates of severe maternal morbidity have highlighted persistent and growing racial disparities in the United States (US). We aimed to contrast temporal trends in peripartum hysterectomy by race/ethnicity and quantify the contribution of changes in maternal and obstetric factors to temporal variations in hysterectomy rates. Methods We conducted a population-based, retrospective study of 5,739,569 US residents with a previous cesarean delivery, using National Vital Statistics System’s Natality Files (2011–2021). Individuals were stratified by self-identified race/ethnicity and classified into four periods based on year of delivery. Temporal changes in hysterectomy rates were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). We used sequential logistic regression models to quantify the contribution of maternal and obstetric factors to temporal variations in hysterectomy rates. Results Over the study period, the peripartum hysterectomy rate increased from 1.23 (2011–2013) to 1.44 (2019–2021) per 1,000 deliveries (OR 2019–2021 vs. 2011–2013 = 1.17, 95% CI 1.10 to 1.25). Hysterectomy rates varied by race/ethnicity with the highest rates among Native Hawaiian and Other Pacific Islander (NHOPI; 2.73 per 1,000 deliveries) and American Indian or Alaskan Native (AIAN; 2.67 per 1,000 deliveries) populations in 2019–2021. Unadjusted models showed a temporal increase in hysterectomy rates among AIAN (2011–2013 rate = 1.43 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.87, 95% CI 1.02 to 3.45) and White (2011–2013 rate = 1.13 per 1,000 deliveries; OR 2019–2021 vs. 2011–2013 = 1.21, 95% CI 1.11 to 1.33) populations. Adjustment ranged from having no effect among NHOPI individuals to explaining 14.0% of the observed 21.0% increase in hysterectomy rates among White individuals. Conclusion Nationally, racial disparities in peripartum hysterectomy are evident. Between 2011–2021, the rate of hysterectomy increased; however, this increase was confined to AIAN and White individuals.

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Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide

Abstract: To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings.

Cited by 11 publications

References 121 publications

Factors influencing second victim experiences and support needs of OB/GYN and pediatric healthcare professionals after adverse patient events

Factors influencing second victim experiences and support needs of OB/GYN and pediatric healthcare professionals after adverse patient events

A retrospective study on epidemiology and outcomes of peripartum hysterectomy

Temporal trends in peripartum hysterectomy among individuals with a previous cesarean delivery by race/ethnicity in the United States: A population-based cohort study

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