Peripartum Hysterectomy for Uncontrolled Obstetric Hemorrhage Under Predominantly Emergency Conditions: A 10-Year Single-Center Experience (2015–2025)

To identify factors associated with peripartum hysterectomy performed within 30 days postpartum. This was a population-based case-control study using Washington State birth certificate registry (1987-2006) linked to the Comprehensive Hospital Abstract Reporting System. Cases underwent hysterectomy within 30 days postpartum. Controls were frequency matched 4:1. Exposures included factors related to hemorrhage, delivery method, multiple gestations, and infection. Incidence rates of peripartum hysterectomy and maternal and neonatal morbidity and mortality were assessed. Adjusted odds ratios (aORs) by maternal age, parity, gestational age, year of birth, and mode of delivery and 95% confidence intervals (CIs) were computed. There were 896 hysterectomies. Incidence rates ranged from 0.25 in 1987 to 0.82 per 1,000 deliveries in 2006 (chi for trend, P<.001). Factors related to hemorrhage were strongly related to peripartum hysterectomy. Placenta previa (192 cases compared with 23 controls; aOR 7.9, 95% CI 4.1-15.0), abruptio placenta (71 compared with 55; aOR 3.2, 95% CI 1.8-5.8), and retained placenta (214 compared with 28; aOR 43.0, 95% CI 19.0-97.7) increased the risk of hysterectomy, as did uterine atony, uterine rupture, and thrombocytopenia. Having multiple gestations did not. As compared with vaginal delivery, vaginal delivery after cesarean (27 cases compared with 105 controls; aOR 1.9, 95% CI 1.2-3.0), primary cesarean (270 compared with 504; aOR 4.6, 95% CI 3.5-6.0), and repeat cesarean (296 compared with 231; aOR 7.9, 95% CI 5.8-10.7) increased the risk of peripartum hysterectomy. Among the 111 women who had hysterectomy on readmission (12.8% of cases), hemorrhage- and infection-related factors were still strongly associated with peripartum hysterectomy. Incidence rates of peripartum hysterectomy are increasing over time. The most important risk factor for peripartum hysterectomy is hemorrhage, most notably caused by uterine rupture, retained placenta, and atony of uterus. II.

IntroductionEmergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman's life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria.MethodsThe case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied.ResultsThere were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%.ConclusionEmergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.

Peripartum hysterectomy (PH), the surgical removal of the uterus during or shortly after childbirth, is a critical procedure in maternal health care. Definitions of PH vary globally, leading to challenges in understanding its occurrence. Our study aimed to provide comprehensive insights into PH in a South African context, investigating indications, demographic characteristics, clinical and histopathological diagnoses, complications, and outcomes. A retrospective record review study design was used, focusing on PH cases at a tertiary facility in Johannesburg, South Africa (SA), between January 2018 and December 2020. Medical records were systematically examined to identify trends, indications, and outcomes associated with PH. Data collection encompassed demographic characteristics, obstetric history, clinical indications, clinical and histopathological diagnoses, and complications. Data analysis used descriptive statistics, interrater reliability tests, and comparative findings with previous SA studies. The study included 56 pregnant women with a median age of 32 years (interquartile range: 25-35) who underwent PH between January 2018 and December 2020 at Charlotte Maxeke Johannesburg Academic Hospital in South Africa. We found that pregnancy-related sepsis (PRS) emerged as the most common indication of PH, as reported among 18 (32.1%) of the women, with an 88.8% histopathological confirmation rate. Abnormal placentation (14/56, 25%) and PPH (8/56, 14%) were other common indications. Clinical and histopathological diagnoses exhibited a strong level of agreement (70.9%), emphasizing the importance of accurate diagnostics. Our study found a shift in the primary historical indications, such as uterine atony and uterine rupture in South Africa, with PRS emerging as the primary indication in recent years(2009-2020). Clinical assessment complemented by histopathological findings remains critical for improved obstetric complication management.

Peripartum hysterectomy is a life-saving procedure performed during and after vaginal delivery or cesarean section. The incidence of placental invasion anomaly is increasing in parallel with the increase in the number of births by cesarean section. It was aimed to evaluate the frequency, risk factors and outcomes of peripartum hysterectomy performed in a tertiary hospital. Research data were obtained by a retrospective review of patient files. Patients who underwent peripartum hysterectomy because of postpartum hemorrhage in the Gynecology and Obstetrics Clinic of Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Turkey, were included in the present study. The patients were divided into two groups as those who underwent emergency peripartum hysterectomy (EPH) and those who did not. Demographic variables, fetal and maternal mortality, EPH indications, additional surgeries performed during EPH, and intra- or postoperative complications were collected. Pearson chi-square test was used for statistical analysis. There were 22,464 deliveries, of which 13,514 were delivered vaginally and 8,950 by cesarean section. Peripartum hysterectomy was performed on 42 patients (vaginal 16, cesarean section 26). The most common EPH indications in both groups were placenta accreta spectrum (42.9/ 3.2%), followed by uterine atony (38.1/ 2.5%). The most common risk factor for EPH was found to be a history of previous cesarean sections. Placental invasion anomalies that cause severe postpartum hemorrhage are due to increased cesarean rates. Currently, the most common indication of EPH is placental invasion anomalies.

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To review cases of emergency peripartum hysterectomy regarding their incidence, risk factors, indications and complications and their results were carefully analysed. A retrospective study of cases of emergency peripartum hysterectomy which were performed in the period between February 1994 and February 2002 at the Princess Badeea Teaching Hospital in Northern Jordan. Demographic and clinical data were extracted and closely interpreted In the study period there were a 70,252 deliveries and 61 cases of emergency peripartum hysterectomies. The overall incidence was 0.87 peripartum hysterectomies per 1,000 deliveries. There were 50 cases (82%) delivered by caesarean section and 11 cases (18%) were delivered vaginally. Caesarean hysterectomy was performed in 50 cases and postpartum hysterectomy was performed in 11 cases. Total hysterectomy was performed in 39 cases (64%) and subtotal hysterectomy was performed in 22 cases (36%). The main indications for hysterectomy were morbidly adherent placenta (47.5%), ruptured uterus (27.9%) and uncontrollable haemorrhage from uterine atony (21.3%). There were two maternal deaths and 7 cases of stillbirths and 4 cases of early neonatal deaths. Peripartum hysterectomy is a dramatic with high risk but a life saving operation. It is usually associated with significant maternal and fetal morbidity and mortality. Obstetricians should identify patients at risk and anticipate the procedure and complications, as early intervention and proper management facilitate optimal outcome.

Background: Peripartum hysterectomy is a life saving procedure performed for intractable obstetric haemorrhage. Uterine atony, rupture, abnormal placentation, retained products etc. are common indications. With the rise of caesarean sections, the incidences of peripartum hysterectomies are increasing worldwide. The aim of the present study is to evaluate the histomorphological findings in peripartum hysterectomy specimens received during a five year period.&#x0D; Material and Method: In this hospital based cross-sectional study during a five year period (Jan 2014 –Dec 2018), 64 peripartum hysterectomy specimens received in the department of Pathology, RIMS, Imphal, Manipur were included. The gross and histomorphological findings were evaluated, studied, statistically analysed and compared with other studies.&#x0D; Results and Observation: The various histomorphological findings were abnormal placentation 28 (43.7%), uterine atony 15 (23.5%), uterine rupture 14 (21.8%), retained placenta/product 6 (9.3%) and subinvolution 1(1.5%). Abnormal Placentation and Placenta cretas were the most common finding in the present study. The lower uterine segment was the most common abnormal site of placental implantation. The age ranged from 21 to 45 years, with majority of the cases were in the 30-39years age group. History of previous caesarean section was noted in 20 cases (31.2%). The relative risk of abnormal placentation was 2.5 times higher in those cases with prior history of caesarean section. Rupture was most commonly associated with multiparous women. Co-morbid overlapping features were seen in few cases.&#x0D; Conclusion: Histopathological diagnosis not only confirmed the clinico-radiological impression, but also highlighted the other co-morbid associations that caused the intractable haemorrhage which warranted a peripartum hysterectomy. &#x0D; Keywords: Peripartum Hysterectomy, Abnormal placentation, caesarean section, chorionic villi.

Objectives: To review the incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy performed after cesarean section and vaginal deliveries. Study design: A nine years retrospective study of all those cases who underwent peripartum hysterectomy at Patan Hospital from the year 1997 to 2005. Results: There were total 28 cases of emergency peripartum hysterectomy, 16 caesarean hysterectomies, and 12 postpartum hysterectomies, with the incidence of 1 per 1364 deliveries. The most common indication for hysterectomy was uterine atony (35.7%) followed by uterine rupture (25%). Average estimated blood loss was 1600 ml, average time from delivery to hysterectomy was 130 minutes, the most common post operative complication was unspecified fever and the average length of hospitalization was 11.17 days. There was only one maternal mortality with 32% maternal morbidity and four perinatal mortality. Conclusion: Peripartum hysterectomy is usually associated with significant maternal and fetal morbidity and mortality yet it remains a potentially life saving procedure. Timely decision to intervene is essential for the optimum outcome. Uterine atony is the leading indication for emergency hysterectomy performed followed by rupture uterus and morbid adherent placenta. Key Words: Caesarean hysterectomy; Peripartum hysterectomy; Postpartum hysterectomy doi:10.3126/njog.v1i2.2395 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 33-36 Nov-Dec 2006

Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey

Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey

Obstetrical & Gynecological Survey: July 2003 - Volume 58 - Issue 7 - p 456-457 doi: 10.1097/01.OGX.0000074390.93515.13

Introduction: Peripartum hysterectomy refers to hysterectomy done during or immediately after delivery for obstetrical reason. The decision of hysterectomy is not an easy one as not doing it could lead to death whereas the surgery results in permanent loss of ability to bear a child and this too in a young woman. Methods: This was a prospective study done over a period of 16 years from 1997 to 2013 by following all cases that underwent hysterectomy for obstetric causes during or after delivery and up to 6 weeks after delivery, in Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Nepal. The various factors were analyzed and data presented in percentages, means and odds ratio was calculated as necessary. P value less than 0.05 was taken as significant. Results: The emergency peripartum hysterectomy rate was 0.05%. Placental abnormality was the most common indication (42.6%) followed by uterine atony (35.7%) and uterine trauma (17.9%). Cesarean Hysterectomy accounted for 50% of the cases. In the last 16 years there was an increased trend of Cesarean section from 18.6% to 30.7% which coincided with an increased Cesarean Hysterectomy from 36.4% in the initial 8 years to 58.8% in the last 8 years. Placental abnormalities as an indication increased over uterine atony in the last 8 years. The most common risk factor was Cesarean section (71.4%) followed by placental abnormalities (42.8%) and previous abortion in 32.1% cases. Conclusion: Emergency Peripartum Hysterectomy rate was 0.05%. Increasing Cesarean section rates were associated with increasing Cesarean Hysterectomy rates.

SummaryThis was a retrospective review of all cases of peripartum obstetric hysterectomy performed at the Istanbul Bakirkoy Women and Children's Teaching Hospital in the period between January 2001 and September 2008. We included any women who required emergency hysterectomy to control major postpartum haemorrhage after delivery. During the study period, there were 91 cases of peripartum hysterectomy. Two controls per case were randomly selected from the remaining births by using the random table. The incidence of emergency peripartum hysterectomy was 0.67 in 1,000 deliveries. The main indication for emergency hysterectomy was uterine atony in 52 cases (57.1%). The most independent risk factors for emergency hysterectomy were multiparity (odds ratios (OR) 17.3, 95% confidence interval (95% CI) 8.7–34.6); caesarean delivery in index delivery (OR 6.7, 95% CI 3.8–11.9) and caesarean section for placental abruption (OR 3.8, 95% CI 0.4–33.4). Our study suggests that multiparity, primary or repeat caesarean deliveries for placental abruption are independently associated risks for peripartum hysterectomy and uterine atony is the still most common indication for peripartum hysterectomy in Turkey.

Peripartum hysterectomy between 2009 and 2010 in Sichuan, China

Emergency peripartum hysterectomy is a life-saving procedure performed as an emergency procedure to control torrential bleeding and it is associated with significant maternal morbidity and mortality. There are only a few studies regarding this topic so this study guides us to monitor the trend and start appropriate policies to reduce unnecessary caesarean deliveries. The aim of this study was to find out the prevalence of peripartum hysterectomy among patients admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of the tertiary care centre. Data from 1 January 2015 to 31 December 2022 were collected between 25 January 2023 and 28 February 2023 from the hospital records. Ethical approval was obtained from the Institutional Review Committee of the same institute (Reference number: 2301241700). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 54,045 deliveries, peripartum hysterectomy was seen in 40 (0.074%) (0.05-0.10, 95% Confidence Interval). The major indication of emergency peripartum hysterectomy was abnormal placentation (placenta accreta spectrum) which was 25 (62.50%) followed by uterine atony in 13 (32.50%) of patients and uterine rupture in 2 (5%). The prevalence of peripartum hysterectomy was lower than in other studies done in similar settings. The indication for Emergency peripartum hysterectomy has changed in recent years from uterine atonicity to the morbidly adherent placenta which is due to a rise in the caesarean section rate. caesarean section; hysterectomy; placenta accreta.