Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries

Kallianidis, Athanasios F.; Maraschini, Alice; Daniš, J; Colmorn, Lotte Berdiin; Deneux‐Tharaux, Catherine; Donati, Serena; Gissler, Mika; Jakobsson, Maija; Knight, Marian; Krištúfková, Alexandra; Lindqvist, Pelle G.; Vandenberghe, Griet; Akker, Thomas van den; Inoss,

doi:10.1111/aogs.14113

Cited by 7 publications

(6 citation statements)

References 29 publications

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“…Similar to studies by Knight et al. 5 and Kallianidis et al, 26 we found a low number of thrombotic events. All four women that experienced a thrombotic event had a histologically verified placenta increta, surgery that lasted over 90 min, and a resuscitative endovascular balloon occlusion of the aorta.…”

Section: Discussionsupporting

confidence: 92%

Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study

Pettersen

Falk

Vangen

et al. 2022

Acta Obstet Gynecol Scand

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Introduction A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies. Material and methods Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy. Results The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications). Conclusions The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications.

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Section: Discussionsupporting

confidence: 92%

Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study

Pettersen

Falk

Vangen

et al. 2022

Acta Obstet Gynecol Scand

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“…The maternal mortality and perinatal mortality rates in the present study were 1.5% and 8.8%, respectively. These rates are comparable to those reported by INOSS analysis of PH cases in different European countries, which ranged from 0% to 3% for maternal mortality and from 3% to 11% for perinatal loss 22 . Nonetheless, the INOSS report included cases of PH performed up to 48 h postpartum, unlike the present study, which accounted for all PH cases performed up to 42 days after birth.…”

Section: Discussionsupporting

confidence: 83%

“…van den Akker et al, 8 conducted a meta‐analysis of 128 studies reporting on outcomes of emergency PH performed within 6 weeks postpartum, and their pooled rates for both maternal and perinatal mortality for high‐income countries were similar to those calculated in the present study. Finally, the ICU admission rate in our study cohort (37.8%) was slightly lower than the admission rates of the other European countries included in the INOSS analysis, which ranged from 48% in Finland to 85% in the Netherlands 22 …”

Section: Discussioncontrasting

confidence: 67%

“…These rates are compa- ranged from 48% in Finland to 85% in the Netherlands. 22 The main strengths of the present study lie in its size, population base, studied duration, and the use of internationally recognized questionnaires. These aspects increase the generalizability of our findings to our population and comparable healthcare settings.…”

Section: Optimal Management Of Map Requires Prenatal Diagnosis To Allowmentioning

confidence: 99%

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Peripartum hysterectomy: A 9‐year population‐based study in Slovakia

Adamec

Vargová

Krištúfková

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications.MethodsThis was a descriptive, population‐based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period.ResultsOf the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%.ConclusionThe incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage.

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“…Higher-income countries report a lower incidence of EPH despite more deliveries by CS, however lower-to-middle income countries (LMICs), where resources are limited, report higher EPH incidence. Possible reasons for these differences may be a delay in referrals and obstructed neglected labor resulting in a uterine rupture in LMICs [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania

et al. 2022

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Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.

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Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries

Cited by 7 publications

References 29 publications

Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study

Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study

Peripartum hysterectomy: A 9‐year population‐based study in Slovakia

Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania

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