Peripartum Hysterectomy: Is There Any Difference Between Emergency and Planned Surgeries?

Melih Velipasaoglu,Tufan Oge,Yusuf Cakmak,Vehbi Yavuz Tokgoz

doi:10.1055/s-0041-1736303

Melih Velipasaoglu, Tufan Oge + Show 2 more

Open Access

https://doi.org/10.1055/s-0041-1736303

Copy DOI

Abstract

To compare the outcomes of emergency and planned peripartum hysterectomies. The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies. A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p = 0.014), and higher postoperative hemoglobin levels (9.9 ± 1.3 versus 8.3 ± 1.3; p < 0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases. Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.

Highlights

Peripartum hysterectomy (PPH) is an important surgical procedure that is typically used to prevent maternal mortality from uterine hemorrhage and sepsis
Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy
The planned PPHs resulted in a lower rate of morbidities and better neonatal outcomes compared with the emergency procedures, which, in turn, required a greater amount of blood products

Summary

Introduction

Peripartum hysterectomy (PPH) is an important surgical procedure that is typically used to prevent maternal mortality from uterine hemorrhage and sepsis. It was first performed at the end of the nineteenth century as a life-saving procedure.[1] The incidence of PPH varies between 0.2 and 6.09 for every thousand deliveries.[2,3] The important risk factors for PPH are age, previous cesarean sections, previous uterine surgery, labor induction, abnormalities in placental invasion, and uterine atony.[4,5] Recent studies[3,6] have reported that the most common indication for PPH was placental invasion anomalies, uterine atony and uterine rupture were the most frequent reasons to perform PPH in the past.[7,8] The increasing trend in cesarean sections might change the indications in favor of anomalies in placental invasion.[9] Most PPH procedures are performed in an unplanned or emergency situation to prevent life-threatening hemorrhage after unsuccessful conservative approaches such as prostaglandins, tamponade, and compression sutures within 24 hour of a delivery. The aim of the present study was to compare the intra-, postoperative, and neonatal outcomes of patients who underwent emergency or planned PPHs

Methods

Results

Discussion

Conclusion