Placenta praevia percreta with silent uterine incomplete rupture complicated with puerperal haemolytic-uremic syndrome

Habek, Dubravko; Petrović, Davor; Vidović, Dražen; Gudelj, Goran

doi:10.1016/j.ejogrb.2006.01.033

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…Langdana et al [1] report on an EPH incidence of 0.03% in 64,563 deliveries, the indications including placenta previa [6] , secondary postpartum hemorrhage [3] , abruptio placenta [3] , postpartum hemorrhage because uterine atony [2] , placenta accreta [2] , traumatic postpartum hemorrhage [1] , and round ligament hematoma [1] . All patients received blood transfusion; 74% receiving more than 10 units.…”

Section: Discussionmentioning

confidence: 99%

“…Peripartum hemorrhage is most commonly caused by uterine atony or coagulopathy (disseminated intravascular coagulopathy or thrombophilia). If there is no response to mechanic (uterus compression, uterine thamponade) or medicamentous therapy (uterotonics, uterostiptics, prostaglandins, recombinant activated factor VII), surgical therapy by vascular sutures is indicated or in present days by conservative compressive procedures like B-Lynch compressive suture or Z-suture of the uterus [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

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Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Habek¹,

Bečarević

2006

Fetal Diagn Ther

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Objective: The aim of the study was to present the incidence, indications, and operative morbidity and mortality in pregnant women undergoing emergency peripartum hysterectomy (EPH) at a tertiary obstetric institution. Methods: In this retrospective clinical study, performed during the period 1995–2003, 17 EPH procedures were recorded in a total of 21,659 deliveries carried out at Department of Gynecology and Obstetrics, Osijek Clinical Hospital in Osijek, Croatia. Data on the incidence of EPH in total number of deliveries, rate of EPH in vaginal delivery and cesarean section, indications for EPH, and maternal and fetal/early neonatal morbidity and mortality were derived from operative protocols and medical records of hospitalized patients. Results: During the 8-year study period, the incidence of EPH in total number of deliveries was 0.078%. Out of 17 EPH procedures, 5 (29.41%) were performed after vaginal delivery and 12 (70.59%) during cesarean section, elective in five and urgent in seven cases. The indications for EPH included severe peripartum hemorrhage with placenta previa in four, placenta previa percreta in four, various forms of invasive malplacentation (placenta accreta, increta, percreta) in five, uterine rupture in two cases, and atony along with massive retroperitoneal hematoma due to rupture of periuterine vascular bundle during cesarean section in one multipara. EPH was carried out in 12 multipara and five primipara. Lesions of urinary bladder occurred in three cases and were managed by suture. Twelve patients received blood transfusion, whereas development of hemorrhagic shock necessitated transfer to Intensive Care Unit in three patients. No late complications or maternal mortality were recorded. Sixteen total hysterectomies and one supracervical hysterectomy were performed. One case of intrauterine fetal death was caused by total abruptio placenta and uterine rupture during the patient’s transport from a primary obstetric institution. Conclusion: Invasive malplacentation is a major isolated risk factor for EPH, as shown in the present study. Other risk factors for EPH are massive hemorrhagy because placenta previa, uterine atony and uterine rupture associated with multiparity, and previous cesarean section. A great proportion of EPH procedures can be prevented by the introduction of compressive operative methods such as B-Lynch suture in the obstetric algorithms, which will certainly favorably reflect in future fertility and genital health of the female population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Habek¹,

Bečarević

2006

Fetal Diagn Ther

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“…In 74% (32/43) of cases, aHUS occurred after an adverse pregnancy outcome (eg, fetal demise, placental abruption, preeclampsia, preterm labor, preterm premature rupture of the membranes, postpartum hemorrhage), while in 26% (11/43) of cases it occurred after an uncomplicated pregnancy. Details of individual aHUS cases 16–53 are summarized in Table S1.…”

Section: Resultsmentioning

confidence: 99%

Differentiating Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome and Atypical Hemolytic Uremic Syndrome in the Postpartum Period

et al. 2021

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Pregnancy-associated atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy which may be mistaken for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We sought to identify laboratory parameters that differentiate aHUS and HELLP syndrome in the postpartum period. PubMed was searched from inception to March 2018 to identify cases of aHUS in the postpartum period, while cases of HELLP syndrome were identified from a cohort of deliveries at our institution from January 2015 to December 2018. Postpartum laboratory data were abstracted as either peak values (AST [aspartate transaminase]; creatinine; LDH [lactate dehydrogenase]) or nadir values (hemoglobin; platelet count). Differences were compared using the t test, Wilcoxon Rank Sum, or χ 2 test, and receiver operating characteristic (ROC) curve analyses were performed. We identified 46 cases of aHUS and 45 cases of HELLP syndrome in the postpartum period. Women with HELLP syndrome were older, but rates of nulliparity and cesarean delivery, and gestational age at delivery, were similar between groups. Peak serum creatinine and LDH values after delivery were the most useful to diagnose aHUS with area under the curve 0.996 (95% CI, 0.99–1.0) and 0.91 (95% CI, 0.83–0.98) respectively. Serum creatinine ≥1.9 mg/dL, LDH ≥1832 U/L, or serum creatinine ≥1.9 mg/dL in combination with LDH ≥600 U/L were the optimal thresholds for diagnosing pregnancy-associated aHUS. We conclude that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to differentiate aHUS and HELLP syndrome in the postpartum period.

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Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data

Gurevich-Shapiro,

Orbach-Zinger,

Leader

et al. 2024

Research and Practice in Thrombosis and Haemostasis

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Placenta praevia percreta with silent uterine incomplete rupture complicated with puerperal haemolytic-uremic syndrome

Cited by 4 publications

References 4 publications

Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Emergency Peripartum Hysterectomy in a Tertiary Obstetric Center: 8-Year Evaluation

Differentiating Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome and Atypical Hemolytic Uremic Syndrome in the Postpartum Period

Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data

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