Abstract
ObjectiveTo audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means.Material and MethodsWe developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009–2012 and made short narratives of all cases.ResultsThe most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies.ConclusionMore than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.
Highlights
Peripartum hysterectomy is a tragedy for a young, fertile woman as it deprives her the chance of having more children
More than 50% of peripartum hysterectomies seem to be avoidable by simple measures
In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and PLOS ONE | DOI:10.1371/journal.pone
Summary
We developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009–2012 and made short narratives of all cases. Data Availability Statement: Data cannot be made publicly available for ethical or legal reasons, e.g., public availability would compromise patient confidentiality or participant privacy. If requested we could apply the Danish National board of health of allowance to share anonymized data for specific purposes and to specific research groups in case of international collaborations. Short narratives are provided as supplemental information. Request for the data may be sent to the corresponding author: Lotte B Colmorn, Department of obstetrics 4031, Juliane Marie Centret, Rigshospitalet, Blegdamsvej
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