Peripartum hysterectomy in the first decade of the 21st century

Abstract

We reviewed the role of peripartum hysterectomy (PH) in the first decade of the 21st century. The study was confined to women who delivered a baby weighing 500 g or more between 2000 and 2009, and who required a hysterectomy within 72 h of delivery for obstetric reasons. Individual case records were reviewed. There were 19 cases of PH in 78,961 deliveries giving an incidence of 1 in 4,156 (0.02%). Of the 19 cases, 95% were delivered by caesarean section and 89% had one or more prior sections. The indications were placental bed pathology (79%), uterine atony (16%) and uterine trauma (5%). Of the 19 hysterectomies, 16 (84%) were total and a gynaecological oncologist was involved in nine (56%) of these cases. There were no maternal or fetal deaths, but a mother required an average blood transfusion of 10 units. The overall rate of PH was remarkably low compared with other studies but it is likely to increase in the future because of the strong association between increasing caesarean section rates and placental bed pathology. The potential involvement of the cervix and other pelvic structures by placental pathology means that PH in the future will be more challenging, and the hysterectomy will need to be total rather than subtotal.

Peripartum Hysterectomy and Analysis of Risk Factors

“…Majority of the women who underwent peripartum hysterectomy had still birth (76%). There was no maternal or fetal death in the similar study conducted by Tadesse et al 16 as the indication differed. Placental pathology being the most common indication as compared to our study where rupture uterus was the most common indication and it is obvious to salvage the fetus following rupture.…”

Clinical analysis of 52 obstetric hysterectomies

“…The literature offers varying reports on PH rates, with the lowest (0.02%) in Ireland and the highest (0.95%) in RPA [4,12]. Data about other countries include 0.024% for Denmark, 0.041% for UK, and 0.146% for the Czech Republic [13][14][15].…”

“…The literature offers definitions ranging from 'until 72 hours postpartum' to '3-6 weeks after birth' [4][5][6]. Inclusion of obstetric hysterectomy into our analysis allows for a complete evaluation of the incidence and prevalence of hysterectomy.…”

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

“…[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.…”

“…[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.…”