Incidence Of Hysterectomy Research Articles

An age-period-cohort analysis of hysterectomy incidence trends in Germany from 2005 to 2019

Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45–49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65–69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches.

The Trend of Cesarean Hysterectomy in Hamadan, Iran, between 2009-2022

Results: The data indicated that out of 114175 deliveries, there were 60 hysterectomies over 14 years with the age range of 20-45 years. The incidence of hysterectomy increased from 0.34/1000 during 2009-2015 to 0.71/1000 deliveries in 2015-2022, with an overall incidence of 0.53 per 1000 deliveries during 14 years. The results indicated that the mean rate of hysterectomy (0.95% CI) increased significantly by 0.059 yearly, and by adjusting other variables, the history of CS (0.95% CI) and placenta accreta previa significantly increased the hysterectomy mean rate by 0.291 (0.053- 0.529) and 0.284 (0.074-0.494), respectively. Conclusion: The mean rate of hysterectomy represented an annual increase, especially during the last 7 years. In summary, the main reason can be the history of CS that leads to placental disorders and, thus, hysterectomy.

Seven-year review of emergency peripartum hysterectomy in a tertiary hospital in northern Nigeria

Background: Emergency peripartum hysterectomy (EPH) is surgical removal of the uterus during childbirth or within its immediate 24 hours, a lifesaving procedure done as the last resort to control obstetric haemorrhage. Objectives: To determine the incidence, indications, and complications of peripartum hysterectomy. Methods: The study is a retrospective review of emergency peripartum hysterectomies performed at the Centre from 1st January, 2015 to 31st December, 2021. The patients’ case folders were retrieved from the medical records department and relevant information obtained using a structured data extraction format. The data was analyzed using SPSS version 26. Means, frequency, and percentages were used to present the significance of the results. Results: A total of 46 EPH were performed between January 2015 and December 2021 out of 20,832 deliveries within the same period, giving an incidence of 0.22% (2.2 per thousand deliveries). Indications were uterine rupture (78.2%), uterine atony (10.9%), abruptio placentae (4.3%), placenta previa (4.3%) and placenta accreta spectrum (2.2%). Subtotal hysterectomy was performed in most cases (39/46; 84.8%). The most common complication was intraoperative haemorrhage requiring blood transfusion (100%). Other complications included severe post-operative anaemia, wound sepsis, paralytic ileus and enterocutaneous fistula. The maternal case fatality was 4 (8.7%) and all the mortality cases were unbooked patients. Conclusion: The incidence of emergency peripartum hysterectomy is relatively low in our study and uterine rupture is the most common indication. EPH is associated with significant maternal morbidity and mortality, and this is related to booking status. Hence, enlightening women on antenatal care and hospital delivery will help in reducing maternal morbidity and mortality.

Gender-Affirming Hysterectomies: Analysis of Temporal Trends and Characteristics Pre- and Post-Expansion of Health Care Coverage at a Large Integrated California Health Care System [ID 2683540

INTRODUCTION: Despite expansion of gender-affirming health care coverage in 2013, few studies have investigated temporal trends in gender-affirming surgeries (GAS) including hysterectomies. Our study aims to investigate the temporal trends of hysterectomies for transgender men and gender-diverse persons (TGD) compared to cisgender women between 2010–2012 and 2013–2019, and annually from 2010 to 2019. METHODS: We conducted an observational retrospective cohort study on TGD and cisgendered patients, aged 18 and older, within Kaiser Permanente Northern California (KPNC) between 2010 and 2019. Data on demographics, surgical characteristics, concurrent procedures, and postoperative complications were extracted from electronic medical records. Bivariate comparisons were performed using chi-squared analysis for categorical variables and t-tests for continuous variables. RESULTS: This study included 41,341 hysterectomies performed within KPNC between 2010 and 2019. Among all hysterectomies, 461 (1.1%) were for TGD. TGD who underwent hysterectomies were more likely to be younger, White, and nulliparous compared to their cisgender counterparts (P<.05). The incidence of hysterectomies remained similar in cisgender women—from 3,750 (99.7%) in 2010 to 4,361 (98.4%) in 2019. For TGD, the incidence of hysterectomies increased gradually—from 10 (0.3%) in 2010 to 70 (1.6%) in 2019, with the largest increase occurring from 40 (1.0%) hysterectomies in 2014 to 62 (1.5%) in 2015. After expansion of GAS coverage, hysterectomy rates increased eightfold from 55 (0.5%) in 2010–2012 to 406 (1.4%) in 2013–2019. CONCLUSION: Gender-affirming hysterectomies have increased substantially because of changes in GAS policies. Future data will evaluate trends of ovarian conservation during concurrent GAS hysterectomy.

Validity of ICD-10 diagnosis codes for placenta accreta spectrum disorders.

The 10th revision of the International Classification of Diseases, Clinical Modification (ICD-10) includes diagnosis codes for placenta accreta spectrum for the first time. These codes could enable valuable research and surveillance of placenta accreta spectrum, a life-threatening pregnancy complication that is increasing in incidence. We sought to evaluate the validity of placenta accreta spectrum diagnosis codes that were introduced in ICD-10 and assess contributing factors to incorrect code assignments. We calculated sensitivity, specificity, positive predictive value and negative predictive value of the ICD-10 placenta accreta spectrum code assignments after reviewing medical records from October 2015 to March 2020 at a quaternary obstetric centre. Histopathologic diagnosis was considered the gold standard. Among 22,345 patients, 104 (0.46%) had an ICD-10 code for placenta accreta spectrum and 51 (0.23%) had a histopathologic diagnosis. ICD-10 codes had a sensitivity of 0.71 (95% CI 0.56, 0.83), specificity of 0.98 (95% CI 0.93, 1.00), positive predictive value of 0.61 (95% CI 0.48, 0.72) and negative predictive value of 1.00 (95% CI 0.96, 1.00). The sensitivities of the ICD-10 codes for placenta accreta spectrum subtypes- accreta, increta and percreta-were 0.55 (95% CI 0.31, 0.78), 0.33 (95% CI 0.12, 0.62) and 0.56 (95% CI 0.31, 0.78), respectively. Cases with incorrect code assignment were less morbid than cases with correct code assignment, with a lower incidence of hysterectomy at delivery (17% vs 100%), blood transfusion (26% vs 75%) and admission to the intensive care unit (0% vs 53%). Primary reasons for code misassignment included code assigned to cases of occult placenta accreta (35%) or to cases with clinical evidence of placental adherence without histopatholic diagnostic (35%) features. These findings from a quaternary obstetric centre suggest that ICD-10 codes may be useful for research and surveillance of placenta accreta spectrum, but researchers should be aware of likely substantial false positive cases.

Changes in use and outcomes after fibrinogen concentrate insurance coverage for critical obstetrical hemorrhage: a nationwide questionnaire survey in Japan

Fibrinogen concentrate (FC) for acquired hypofibrinogenemia associated with critical obstetrical hemorrhage (COH) was covered by public medical insurance in September 2021 in Japan. We aimed to investigate changes in the policy of FC use and its effect on COH after insurance coverage. A primary survey covering September 2020 to August 2021 and a secondary survey covering September 2021 to August 2022 were conducted at 428 higher-level medical facilities. We investigated the policy of FC use in transfusion strategy and the maternal outcomes in COH. Among the hospitals that responded to both surveys, the number of facilities that use FC increased from 51.5 (101/196) to 78.6% (154/196) (P < 0.0001). The number of COH cases treated using FC increased from 14.3 to 24.3% (P < 0.0001) and that transfused with ≥ 10 units of red blood cells (RBCs) decreased from 36.8 to 29.8% (P = 0.001). The incidence of pulmonary edema reduced by 3.7–2.0% (P = 0.021), and transfusion-induced allergy by 1.9–0.7% (P = 0.008). No changes were observed in the incidence of thromboembolism, arterial embolization, or hysterectomy. The increased use of FC after insurance coverage led to changes in the transfusion strategy, which may be associated with decreases in transfusions of RBCs, pulmonary edema, and transfusion-induced allergies.

Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands

ObjectivesAmong women with severe PPH (sPPH) in France and the Netherlands, we compared incidence of adverse maternal outcome (major obstetric hemorrhage (≥2.5L blood loss) and/or hysterectomy and/or mortality) by mode of delivery. Second, we compared use and timing of resuscitation and transfusion management, second-line uterotonics and uterine-sparing interventions (intra-uterine tamponade, compression sutures, vascular ligation, arterial embolization) by mode of delivery. MethodsSecondary analysis of two population-based studies of women with sPPH in France and the Netherlands. Women were selected by a harmonized definition for sPPH: (total blood loss ≥ 1500 ml) AND (blood transfusion of ≥ 4 units packed red blood cells and/or multicomponent blood transfusion). FindingsIncidence of adverse maternal outcome after vaginal birth was 793/1002, 9.1 % in the Netherlands versus 88/214, 41.1 % in France and 259/342, 76.2% versus 160/270, 59.3% after cesarean. Hemostatic agents such as fibrinogen were administered less frequently (p < 0.001) in the Netherlands (vaginal birth: 83/1002, 8.3% versus 105/2014, 49.5% in France; cesarean: 47/342, 13.7% and 152/270, 55.6%). Second-line uterotonics were started significantly later after PPH-onset in the Netherlands than France (vaginal birth: 46 versus 25 min; cesarean: 45 versus 18 min). Uterine-sparing interventions were less frequently (p < 0.001) applied in the Netherlands after vaginal birth (394/1002,39.3 %, 134/214, 62.6%) and cesarean (133/342, 38.9 % and 155/270, 57.4%), all initiated later after onset of refractory PPH in the Netherlands. InterpretationIncidence of adverse maternal outcome was higher among women with sPPH in the Netherlands than France regardless mode of birth. Possible explanatory mechanisms are earlier and more frequent use of second-line uterotonics and uterine-sparing interventions in France compared to the Netherlands.

The incidence, indications, risk factors and pregnancy outcomes of peripartum hysterectomy at a tertiary hospital between 2013 and 2022.

To analyze the incidence, indications, risk factors and pregnancy outcomes of postpartum hemorrhage resulting in peripartum hysterectomy (PH). We retrospectively reviewed patients with postpartum hemorrhage requiring surgical procedures at ≥ 28weeks of gestation from January 1, 2013 to December 31, 2022 at a tertiary hospital in Shanghai, China. The patients were divided into a PH group and a non-PH group. Maternal clinical characteristics, the management of postpartum hemorrhage, pregnancy outcomes were compared between groups. Logistic regression was used to analyze the correlations between risk factors and PH. The incidence of hysterectomy was 0.2/1000 deliveries (31/150194). The variables significantly associated with PH were placenta previa with placenta increta/percreta (OR36.26), uterine rupture (OR266.16) and an estimated blood loss ≥ 3513mL (OR431.11). The proportion of cases involving hemorrhagic shock, disseminated intravascular coagulation, bladder injury, neonatal severe asphyxia, neonatal death and hypoxic-ischemic encephalopathy were significantly higher in the PH group (P < 0.05). The most common indications of PH were placental pathology. Efforts should be made to reduce the rate of cesarean deliveries and uterine curettage to lower the probability of abnormal placental invasion and appropriate medical indications for trial of labor after cesarean should be strictly followed to avoid the risk of uterine rupture.

5-year review of hysterectomy at the Delta State University Teaching Hospital, Oghara, south-south Nigeria

Context: Hysterectomy is a major surgical procedure that is performed worldwide for several indications ranging from benign to malignant conditions. It may be life-saving especially in certain obstetric situations.&#x0D; Objective: The aim was to determine the incidence, indications and complications of hysterectomy in Delta State University Teaching Hospital (DELSUTH), Oghara.&#x0D; Materials and methods: This was a retrospective descriptive study of hysterectomy performed in DELSUTH, Oghara from January 1st, 2012 to December 31st 2016. Every patient that had hysterectomy was included.&#x0D; Results: During the period, there were there 468 major gynaecological surgeries. Eighty-five patients had hysterectomy accounting for 18.2%. The mean age of the patients was 47.9±10.6 years. Majority (46.6%) of the patients were para 5 and above. The mean parity was 3.2±0.83. Uterine fibroid accounted for majority (30.0%) of the cases. Total abdominal hysterectomy accounted for 78.75% while 8.75% had sub-total abdominal hysterectomy and 12.5% had vaginal hysterectomy. Fifty-two percent of the patients had bilateral salpingo-oophorectomy while 6.25% had unilateral salpingo-oophorectomy. Anaemia and wound sepsis were the most common complications. One patient (1.25%) ended as a mortality during the period under review.&#x0D; Conclusion: The indications for, and surgical outcome following hysterectomy are comparable to that from other public hospitals across the country.

Peripartum hysterectomy: A 9-year population-based study in Slovakia.

To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. This was a descriptive, population-based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage.

Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis.

To assess the risk of hysterectomy after nonresectoscopic endometrial ablation in patients with heavy menstrual bleeding. The EMBASE, MEDLINE, ClinicalTrials.gov and Cochrane databases were searched for eligible articles from inception until June 13, 2022. We used combinations of search terms for endometrial ablation and hysterectomy. Articles included in the review described the incidence of hysterectomy at a specific point in time after ablation with a minimum follow-up duration of 12 months. The literature search yielded a total of 3,022 hits. A total of 53 studies met our inclusion and exclusion criteria, including six retrospective studies, 24 randomized controlled trials, and 23 prospective studies. A total of 48,071 patients underwent endometrial ablation between 1992 and 2017. Follow-up duration varied between 12 and 120 months. Analyses per follow-up moment showed 4.3% hysterectomy rate at 12 months of follow-up (n=29 studies), 11.1% at 18 months (n=1 study), 8.0% at 24 months (n=11 studies), 10.2% at 36 months (n=12 studies), 7.6% at 48 months (n=2 studies), and 12.4% at 60 months (n=6 studies). Two studies reported a mean hysterectomy rate at 10 years after ablation of 21.3%. Minimal clinically relevant differences in hysterectomy rates were observed among the different study designs. Furthermore, we found no significant differences in hysterectomy rate among the different nonresectoscopic endometrial ablation devices. The risk of hysterectomy after endometrial ablation seems to increase from 4.3% after 1 year to 12.4% after 5 years. Clinicians can use the results of this review to counsel patients about the 12% risk of hysterectomy 5 years after endometrial ablation. PROSPERO, CRD42020156281.

Systemic Progestins and Progestin-Releasing Intrauterine Device Therapy for Premenopausal Patients With Endometrial Intraepithelial Neoplasia.

To estimate trends in use and outcomes of progestin therapy for premenopausal patients with endometrial intraepithelial neoplasia. The MarketScan Database was used to identify patients aged 18-50 years with endometrial intraepithelial neoplasia from 2008 to 2020. Primary treatment was classified as hysterectomy or progestin-based therapy. Within the progestin group, treatment was classified as systemic therapy or progestin-releasing intrauterine device (IUD). The trends in use of progestins and the pattern of progestin use were examined. A multivariable logistic regression model was fit to examine the association between baseline characteristics and the use of progestins. The cumulative incidence of hysterectomy, uterine cancer, and pregnancy since initiation of progestin therapy was analyzed. A total of 3,947 patients were identified. Hysterectomy was performed in 2,149 (54.4%); progestins were used in 1,798 (45.6%). Use of progestins increased from 44.2% in 2008 to 63.4% in 2020 ( P =.002). Among the progestin users, 1,530 (85.1%) were treated with systemic progestin, and 268 (14.9%) were treated with progestin-releasing IUD. Among progestin users, use of IUD increased from 7.7% in 2008 to 35.6% in 2020 ( P <.001). Hysterectomy was ultimately performed in 36.0% (95% CI 32.8-39.3%) of those who received systemic progestins compared with 22.9% (95% CI 16.5-30.0%) of those treated with progestin-releasing IUD ( P <.001). Subsequent uterine cancer was documented in 10.5% (95% CI 7.6-13.8%) of those who received systemic progestins compared with 8.2% (95% CI 3.1-16.6%) of those treated with progestin-releasing IUD ( P =.24). Venous thromboembolic complications occurred in 27 (1.5%) of those treated with progestins; the venous thromboembolism (VTE) rate was similar for oral progestins and progestin-releasing IUD. The rate of conservative treatment with progestins in premenopausal individuals with endometrial intraepithelial neoplasia has increased over time, and among progestin users, progestin-releasing IUD use is increasing. Progestin-releasing IUD use may be associated with a lower rate of hysterectomy and a similar rate of VTE compared with oral progestin therapy.

Dienogest versus norethisterone acetate in management of endometrial hyperplasia without atypia

ObjectivesTo compare the effectiveness of dienogest (DIE) and norethisterone acetate (NETA) regimens in the treatment of endometrial hyperplasia (EH) without atypia.MethodsParticipants were premenopausal women with irregular uterine bleeding, and endometrial hyperplasia without atypia on endometrial biopsy. Enrolled patients were randomly allocated into two groups: group I got DIE 2 mg/day (orally Visanne) for 14 days (10th to the 25th day of cycle) while group II received between the 16th and 25th day of the cycle, norethisterone acetate (NETA) 15 mg/d (orally Primolut Nor) was administered for 10 days. Both groups continued the therapy for six months.ResultsThe DIE group showed a higher resolution (32.7%) and regression (57.7%) than NETA group (31% & 37.9%, respectively) with significant regression (p = 0.039). No progression in DIE group while four (6.9%) women in NETA group were recorded a progression to complex type without a significance. Also, NETA group showed a significant persistence rate (22.5%) than DIE group (3.8%) (p = 0.005). Also number in NETA group managed by hysterectomy with significant difference (p = 0.042).ConclusionIf used as first-line treatment, Dienogest produces a better rate of regression and a lower incidence of hysterectomy than Norethisterone Acetate does when used in EH without atypia.

Emergency Cesarean Hysterectomy Among Women attending to Obstetric Unit in Al-Thowrah Hospital, Sana,a City, Yemen

Background: Peripartum hysterectomy is a major operation and is invariably performed in the presence of life threatening hemorrhage during or immediately after abdominal or vaginal deliveries. Aim: To determine the incidence and indication of cesarean hysterectomy, among women attending to the obstetric unit in Al-Thowrah modern general hospital, Sana, a City, Yemen. Methods: A total of 60 women cesarean underwent hysterectomy were enrolled in the study. Data were collected from labor registers, theater records, patient cases notes, ward registers and intensive care unit records. Results: During the period of study there were 60 cesarean hysterectomy and 54500 deliveries, representing an incidence rate of 1.1 cases per 1000. Vaginal delivery was the most common mode of delivery (83.3%) followed by a cesarean section (16.7%), and cesarean hysterectomy (0.11%). Most of the women with cesarean hysterectomy were in the age group of 30-39 years (56.7%), 23.3% of women were older than 40 years, and the least were at age group less than 30 years (20%). The majority of women were grand multipara (80%) while 16.7% were multipara and only two women (3.3%) were primigravida. Cesarean hysterectomy was performed in two-thirds of women at the gestational age of 37 weeks or more and in one third at the gestational age of less than 37weeks. The most common indication for cesarean hysterectomy was rupture uterus (58.3%), massive hemorrhage due to the placenta (15%). Placenta previa, uterine atony, and placenta adherent were indicated in 11.7%, 8.3%, 6.7%, respectively. There were 53 stillbirths and 7 alive birth. The most common causes of death were placental abruption, ruptured uterus, and prematurity. There was 10 maternal death (16.7%) due to DIC in 6 women as a complication of massive hemorrhage and acute renal failure in 4 patients. There were 42 maternal complications. These were due to shock (bleeding) in 14, DIC in ten, anemia in eight, acute renal failure in seven, and ureteric ligation in three. Conclusion: The incidence of cesarean hysterectomy was very high, and the most common causes were found to be due to rupture uterus and PPH due to uterine atony and abruption placenta and placenta previa. The maternal mortality rate was found to be very high and the prenatal mortality rate also was very high.

Uterine rupture

The increasing rate of elective and indicated caesarean sections worldwide has led to new pathologies and management challenges. The number of patients undergoing trial of labor after caesarean section (TOLAC) is also increasing. Three professional societies provide detailed guidelines based on scientific evidence for the management of patients attempting vaginal birth after caesarean section (VBAC). However, they do not provide any recommendations for the actual surgical steps to be followed to minimize the risks of uterine rupture (UR) during TOLAC. Uterine scar condition, intrapartum management and maternal health status correlate to uterine scar rupture risk and provide guidance for parturient TOLAC eligibility. TOLAC and vaginal delivery success rate as reported by the largest studies is between 60% and 77%. Uterine rupture is more prevalent in VBAC-2 patients (1.59%) in contrast to VBAC-1 (0.72%). Additionally, VBAC-2 patients have higher incidence of caesarean hysterectomy 0.56% vs. 0.19% for VBAC-1. The chances of successful VBAC increase when the interpregnancy/interdelivery interval is less than 6.3 years and less than 24 months, respectively. No difference was detected between the techniques of uterine incision closure of the previous CS and TOLAC results, although closure of the CS uterine incision in 2 layers seems to be practiced more widely. Niche or isthmocele presents another complication of CS. Secondary infertility due to niche, will eventually direct to hysteroscopic or laparoscopic repair, depending on the residual myometrial thickness (RMT) as measured by US scan. When RMT is below 3 mm or 2.5 mm surgery can be performed, to prevent any spontaneous UR in case of pregnancy. Monitoring by US scanning of hysterotomy scar after myomectomy can detect hematoma. In patients with severe postoperative pain but hemodynamically stable follow up by US scan examination can direct the management decision. In those patients with active bleeding and deterioration of hysterotomy scar edema will be an indication to surgery. There is no firm evidence regarding which type of thread, knotting or sequence of suturing is more favorable to reduce the risk of UR after VBAC or hysterotomy after myomectomy.

Perinatal Outcomes of Pregnancy in Women with Scarred Uteri.

Uterine scarring is risky for the pregnancy and is closely associated with adverse pregnancy outcomes. Here, we investigated risk factors and associated perinatal outcomes in singleton pregnant women with uterine scars. This retrospective cohort study was conducted on singleton pregnant women who delivered at the West China Second University Hospital between January 1, 2021, and December 31, 2021. The control group included 13,433 cases without uterine scars. The study group involved 2397 cases with one previous cesarean delivery (PCD), 163 cases with two PCDs, 12 cases with three PCDs, and 184 cases with non-cesarean uterine scars. The study group had a significantly higher incidence of placenta previa (6.4%), placenta percreta (5.3%), preterm delivery (10.3%), postpartum hemorrhage (3.4%), uterine rupture (9.4%), hysterectomy (0.18%), and bladder injury (0.4%) when compared with the control group (P <0.05). The scarred uterus cases with 1, 2, or 3 PCDs had significantly different complications, with the higher PCD frequency correlating with increased rates of placenta previa, placenta percreta, postpartum hemorrhage, uterine rupture, and uterine resection. Moreover, the hospitalization time, cesarean operation time, and intrapartum bleeding in the current pregnancy significantly increased with increasing PCD frequency (P <0.05). Analysis of the association between the duration of the interval between PCD and re-pregnancy and pregnancy complication revealed that the incidence of pernicious placenta previa was statistically higher in cases with intervals of <2 years or ≥5 years (4.7%) than in cases with 2 years ≤ interval time <5 years (2.5%) (P <0.05). Pregnancies with uterine scars may experience higher rates of adverse perinatal outcomes. This calls for increased observation during pregnancy and delivery to reduce maternal and fetal complications.

Incidence and determinants of hysterectomy among North Indian women: An 8-year follow-up study.

Despite indications of a rapid increase in the number of hysterectomies performed in India, very few studies have methodically investigated the rate and determinants of the incidence of hysterectomy. The present study aims to estimate the rate of incidence of hysterectomy and identify predictors/determinants of incident hysterectomy in a cohort of North Indian women. In the present study, a cohort of 1,009 ever-married North Indian women (aged 30-75 years) was followed up after a median of 8.11 years. Those hysterectomized at the baseline (63) were excluded; and of the rest 946 participants, 702 (74.2%) could be successfully followed-up. During the baseline assessment, data about sociodemographic variables, reproductive history, menopausal status, physiological health, and selected blood biochemicals were collected. During the end-line assessment, data about sociodemographic variables, current menopausal status, and incident hysterectomy were recorded. The overall rate of incidence of hysterectomy was found to be 11.59 per 1,000 women-years, in the study population. Interestingly, the incidence rates were found to be similar among pre- and post-menopausal women. Further, while late age at menarche was found to be negatively associated with incident hysterectomy, folate repletion and high triglyceride (TG) at the baseline were found to be positively associated. High rate of incident hysterectomy in the studied population points toward the huge burden of gynecological morbidity and the unavailability of non-invasive protocols. Such a situation warrants immediate policy intervention. Further, maintaining TG and folate within normal physiological ranges may be beneficial in gynecological ailments necessitating hysterectomy.

Outcomes of single port robotic sacrocolpopexy compared with multi-port approaches

ImportanceScientific literature currently lacks data on surgical outcomes of single-port robotic sacrocolpopexy compared with traditional multi-port approaches. ObjectivesTo evaluate feasibility and surgical outcomes for the single-port robotic approach to sacrocolpopexy when compared with traditional multi-port approaches. Study designRetrospective chart review of fifty patients who underwent minimally invasive sacrocolpopexy with a single urogynecologist between 2018 and 2021 ​at an academic tertiary care hospital. Patients were divided into three cohorts: laparoscopic multi-port (LMP), robotic multi-port (RMP), and robotic single-port (RSP). Outcome measures were operative time, number of adverse events, and severity of adverse events by Clavien-Dindo. ResultsAll patients underwent at least one concomitant procedure; however, LMP had more concomitant procedures compared to RMP and RSP (p ​< ​0.001). RMP had higher incidence of prior hysterectomy (p ​< ​0.001) and prior vaginal surgery (p ​= ​0.002) compared to LMP and RSP. There were no significant differences in age, BMI, ethnicity/race, pre-operative POPQ stage, number of prior laparoscopies/laparotomies, or prior hernia repair. Linear and Poisson regression models were used to assess between-group differences in the outcome measures while adjusting for confounders. LMP had significantly higher adverse event severity than RSP (RR ​= ​2.23, p ​= ​0.044). 62.5% of the RSP group had no adverse events. No other statistically significant differences were observed. ConclusionThis retrospective study demonstrates feasibility and safety of the single-port robotic approach for sacrocolpopexy when compared with traditional multi-port approaches. Larger, prospective studies are indicated to better understand post-operative outcomes.

Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis.

To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings. PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021. Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8,775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting. The meta-analysis included 154 studies: 14,409 emergency peripartum hysterectomies were performed in 17,127,499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1,000 births (95% CI 1.0-1.3). The highest incidence was observed in lower middle-income settings (3/1,000 births, 95% CI 2.5-3.5), and the lowest incidence was observed in high-income settings (0.7/1,000 births, 95% CI 0.5-0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9-42.4), uterine atony (27.0%, 95% CI 24.6-29.5), and uterine rupture (21.2%, 95% CI 17.8-25.0). In lower middle-income countries, uterine rupture (44.5%, 95% CI 36.6-52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5-53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2,706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3-81.9). The most common complications were febrile (29.7%, 95% CI 25.4-34.3) and hematologic (27.5%, 95% CI 20.4-35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5-4.2) and was higher in lower middle-income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9-14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6-1.6). Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.

Comparative Study between Different Methods of Laparoscopic Hysterectomies

Background: Hysterectomy is the second most common major surgical procedure performed on women after caesarean section. The incidence of hysterectomy is 4-6% out of which 90% are performed for benign indications. Aim of the work: The aim of this study was to compare intra- and post-operative morbidity associated with two types of laparoscopic hysterectomy. Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) Patients and methods: A total of 80 women scheduled to undergo a hysterectomy for benign disease were subdivided into 2 groups; 40 women for LAVH and 40 women for TLH, Patients were excluded from the study if they had contraindication to laparoscopy. Intra- and post-operative evaluations including the duration of the operation uterine weight, frequency of intraoperative complication, and the difference between hemoglobin level prior to surgery and one day after surgery. Results: LAVH took the longest operating time. As regard hemoglobin deficit that occurred after 24 hours of surgery, our study showed that TLH had largest Hb deficit (1.6 gm/dl) but still the Hb deficit not significantly different. As regard transfusion of blood, one case took blood in group LAVH and one case in group TLH. As regard other complications, the bladder was injured during plunt dissection of the bladder flap in group TLH and this case was having history of one cesarean section 10 years ago. Conclusion: laparoscopic assisted vaginal hysterectomy showed lower complication but longer operative time than total laparoscopic hysterectomy group; also (LAVH) showed shorter hospital stay and need fewer analgesics so we considered this method the best when the patient accepted total removal of the uterus. While total laparoscopic hysterectomy showed the more blood loss and complication intraoperatively and postoperatiovely, but this complication is non-significant in cases of removal of the hole uterus.