Incidence Of Hysterectomy Research Articles

The impact of uterine artery embolization to reduce postpartum hysterectomy

Uterine artery embolization (UAE) has been part of treatment options for postpartum hemorrhage (PPH) at Oslo University Hospital since 2007. We wanted to investigate if introduction of UAE influenced the incidence of postpartum hysterectomy and in addition to evaluate clinical success and fertility after UAE. This retrospective study includes patients treated for severe PPH undergoing UAE from 2007 to 2010 and patients undergoing hysterectomy in the period before (2003–2006) and after (2007–2010) the introduction of UAE. Hospital records were reviewed. Patients who were embolized were contacted with a questionnaire to evaluate fertility. We observed a decrease in the incidence of postpartum hysterectomy since introduction of UAE for PPH; however, the reduction was not significant (0.40/1000 versus 0.35/1000, p = 0.80). UAE resulted in clinical success in 28 patients (82 %). None were re-embolized. Twenty women were hysterectomized. Five of these patients had preceding embolization, four were hysterectomized due to re-bleeding, and one due to sepsis with suspected uterine necrosis. One patient had a uterine horn removed due to bleeding. Nine women became pregnant after UAE. There were 11 reported pregnancies and 8 live births. PPH re-occurred in 63 % of live births, with median bleeding volume of 700 ml (range 500–1600 ml). Introducing UAE decreased postpartum hysterectomy rate in our department, however not significant. Our success rate of UAE (82 %) is in line with previously published data. UAE may preserve fertility potential. High recurrence rate of PPH after previous UAE was observed.

Obstetric outcome associated with trial of labor in women with three prior cesarean delivery and at least one prior vaginal birth in an area with a particularly high rate of cesarean delivery

Objective: The objective of this study is to evaluate maternal and neonatal outcomes associated with trial of labor after cesarean (TOLAC) in women with three prior cesarean delivery (CD) and at least one prior vaginal delivery.Methods: This is a retrospective study using data collected from clinical records of women three prior CD and at least one prior vaginal delivery who were referred to our unit. Maternal and perinatal outcomes were compared between women with three prior CD who underwent TOLAC and those who underwent planned repeated CD (i.e. control group). The primary outcome was a composite of maternal complications including at least one of the followings: need for blood transfusion, uterine rupture, hysterectomy, and admission to intensive care unit.Results: Fifty singleton gestations with three prior CD at with at least one prior vaginal birth were analyzed. Of them, 10 accepted to undergo TOLAC. Of the 10 women who underwent TOLAC, nine had vaginal birth and one had CD for non-reassuring pattern. We found no significant differences in the primary outcome, in need for blood transfusion, in the incidence of uterine rupture, hysterectomy, and admission to intensive care unit comparing TOLAC group with controls.Conclusion: TOLAC in women with three prior CD and at least one prior vaginal delivery is a viable option and is not associated with higher risk of adverse maternal or fetal outcomes.

Outcomes of low-risk prostate cancer with robotic-assisted laparoscopic radical prostatectomy in our center

s / Urological Science 26 (2015) 294e300 300 female subjects. The hazard ratio (HR) of hysterectomy in non-IC/BPS cohort compare with IC/BPS cohort is 2.932 (95% CI1⁄4 2.018-4.261, p1⁄4 .000) after controlling the age and five comorbidities by Cox regression analysis Conclusions: Our results imply us that the incidence of hysterectomy was lower, instead of higher, in PBS/IC female patient after PBS/IC diagnosed in these matched subjects. That is, PBS/IC is a protective factor of hysterectomy for Taiwan female. The incidence of hysterectomy of PBS/IC female patient before PBS/IC diagnosed should be further investigated to clarify the relationship between PBS/IC and hysterectomy. MP4-5: OUTCOMES OF LOW-RISK PROSTATE CANCER WITH ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY IN OUR CENTER Keng-Kok Tan, Kun-Hung Shen, Chien Liang Liu, Steven K. Huan. Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan Purpose: In prostate cancer, very low-risk tumors are often managed well with active surveillance, low to intermediate-risk tumors generally respond well to localized treatment (surgery or radiation alone, brachytherapywith or without external-beam therapy). Intermediate to high-risk tumors often require multimodal therapy (surgery with radiation, or radiation therapy with hormonal therapy). All available treatments for prostate cancer carry a risk of complications, side effects, and other impacts to the patient's long-term quality of life. Therefore, some practice suggested active surveillance in low-risk patient to avoid over treatment and complication. However, new surgical technique and instrument development, there can decrease surgical complication and improve patient outcome. We present the outcome of low-risk prostate cancer with robotic-assisted laparoscopic radical prostatectomy (RALRP) in our institution. Materials and Methods: From April 2012 to August 2015, 128 male patients with prostate cancer underwent RALRP in Chi Mei Medical Center. We follow the NCCN prostate cancer treatment guideline in our clinical practice. Patient characteristics, DRE, PSA, Gleason score, preoperative clinical staging, postoperative data and outcomes including final pathological staging, continence, potency, biochemical recurrence, postoperative complications and surgical margins were analyzed. Results: Only 7 patients are low risk group, the rest of 121 patients are intermediate, high and very high risk group. The average age of the low risk patients was 65.3 years (47~73). Pre-op mean PSA was 4.65 ng/ml (1.8~5.59), only 2 patients had palpable hard nodule while DRE, Gleason score were (3+3) in 6 patients and (2+2) in 1 patient. Post operation pathology showed margin free in all 7 cases, but 4 patients up-staging to T2c, 5 patients had total Gleason score 7 points and 6 patients shift to intermediate risk group compare to pre-op evaluation. After 6 weeks of surgery, PSA decrease to <0.01 ng/ml in all patient and during mean f/u times 19 months (9~33), no biochemical recurrence was noted. Conclusion: Although pre-op are low-risk group, but we found that more than half of the patient showed up-staging and up-grading after operation. Due to the robotic assisted system development, less complication and better outcome can be expected. May by operation can provided better oncology outcome in low-risk prostate cancer patient. MP4-6: ESWL POTENTIALLY IMPROVE RENAL FUNCTION IN UROLITHIASIS INTERVENTION. AN EXPERIENCE FROM SHOW CHWAN MEMORIAL HOSPITAL Wong Jin-Kiong , Lin Mao-Sheng , Lin Ta-Chong , Wang ChienHsiang , Chou chih-yuan , Wu Chyi-Hsiang , Hsih Hui-Lung , Chen Chao-Chih . Department of Urology, Chang Hua Show Chwan Memorial Hospital, Taiwan; Department of Urology, Chang Bin Show Chwan Memorial Hospital, Taiwan; Department of Urology, Chu Shang Show Chwan Memorial Hospital, Taiwan; 4 Sun Mei Urology Clinic, Taichung,

Clinical Analysis of 38 Cases of Obstetric Emergency Hysterectomy

&lt;strong&gt;Objective:&lt;/strong&gt; To discuss and analyze the clinical situation of emergency obstetric hysterectomy. &lt;strong&gt;Methods:&lt;/strong&gt; Retrospective analysis of the clinical data of 38 cases obstetric emergency hysterectomy medical records from 2002 to 2011 in our hospital is made. &lt;strong&gt;Result:&lt;/strong&gt; 38 cases of emergency obstetric hysterectomy indications are uterine massive bleeding. placental factor medical records are 20 cases, accounted for 52.3%, with the cure rate of 97.4%, and perinatal child mortality rate is 7.9%. &lt;strong&gt;Conclusion:&lt;/strong&gt; Hysterectomy is a quick, effective means of treatment of acute obstetric massive bleeding, effectively reduced the rate of cesarean section, also can reduce the incidence of obstetric hysterectomy.

The incidence of hysterectomy, uterus-preserving procedures and recurrent treatment in the management of uterine fibroids

ObjectiveTo determine the incidence of hysterectomy and uterus-preserving procedures (UPPs) among women with uterine fibroids (UFs) and the incidence of further procedures after a UPP. Study designThis was an observational study using a primary care database, The Health Improvement Network (THIN). Women in THIN with UFs aged 15–54 years between January 2000 and December 2009 were eligible for study. The UPPs examined were myomectomy, endometrial ablation (EA) and uterine artery embolization (UAE). Using Read codes, women were followed up until one of the following was met: there was a record of hysterectomy or UPPs, they died or the study ended (end of 2010). ResultsThe cumulative incidence of hysterectomy or UPPs was 23.6% at 1 year, and 40.9% after the follow-up period (median 3.6 years). At the end of the follow-up period, the cumulative incidences of hysterectomy, myomectomy, EA and UAE were 33.0%, 3.9%, 6.4% and 1.9%, respectively. For women initially treated with a UPP, the cumulative incidence of second procedures was 11.5% at 1 year. At the end of the follow-up period (median 2.7 years), the cumulative incidence of further procedures was 26.1%, and the cumulative incidences of women undergoing hysterectomy, myomectomy, EA and UAE were 19.0%, 4.3%, 3.4% and 1.4%, respectively. ConclusionsWomen considering UPPs for the management of UFs should be made aware that the incidence of further treatments is high, with hysterectomy being the most frequent procedure undergone.

Comparison of blood transfusion and surgical complications in peripartum hysterectomy when anticipated and unanticipated

The aim of the study was to determine the incidence and aetiology of peripartum hysterectomy (PH) for major obstetric haemorrhage (MOH) in our population and to compare estimated blood loss (EBL), blood transfusion, surgical complications and duration of hospital stay in PH that was anticipated and PH that was unanticipated. 26 cases of MOH requiring PH were identified from 50,548 women who delivered between 1 January 2006 and 31 December 2011 (0.5/1000). PH was anticipated in 17 and unanticipated in 9 cases. When compared, the anticipated group was more likely to have placenta accreta 15/17 (88%) vs 4/9 (44%): p = 0.03 and a gynaecological oncologist as the principal operator 15/17 (88%) vs 3/9 (33%): p = 0.007. The EBL 5.5 ± 3.7 SD vs 6.6 ± 3.9 SD l; p = 0.5, units of red cell concentrate or RCC transfused 7 ± 5 SD vs 9 ± 5 SD: p = 0.3, and mean operating time 134 ± 60 SD vs 190 ± 96 SD min: p = 0.07 were less in the anticipated than the unanticipated group, but not significantly so. The intraoperative complication rate 7/17 (41%) vs 3/9 (33%): p = 1.0 and the mean duration of hospital stay 7 ± 1 SD vs 8 ± 3 SD days: p = 0.27 were similar in both groups. PH is associated with a large volume of blood loss and significant surgical complications regardless of whether the procedure is anticipated or not.

La ruptura uterina y la conducta conservadora iatrogénica

El autor afirma que desde 1932 la Clínica Obstétrica de la Facultad de Medicina de la Universidad de Sao Paulo está preocupada con el tratamiento conservador de infra-parto ruptura del útero. Por lo tanto, desde ese momento la histerectomía se ha sustituido por la sutura uterina con laceración de trompas cuando la extensión y las características de la lesión del miometrio sugiere la ruptura del riesgo en los embarazos y partos futuros. El autor se refiere 172 casos de ruptura uterina observada durante 1919-1962. La incidencia de la histerectomía se redujo de 37,2% (en el período 1919-1944) a 11,5% (en 1952-1958) y el promedio de la incidencia de histerectomía fue 21,5% para el período total de 1919 a 1962.

English

OBJECTIVE: To determine the incidence, indications, maternal and perinatal outcome of emergency peripartum hysterectomy. METHOD: A prospective observational study of all patients who underwent peripartum hysterectomy was conducted from June 2011 to November 2012 in the Department of Obstetrics and Gynecology, Lalla Ded Hospital, an associated hospital of Government Medical College, Srinagar, Kashmir. Data, specifically on the incidence of emergency peripartum hysterectomy, the total number of deliveries, the maternal parameters, the indications of peripartum hysterectomy and associated maternal morbidity and mortality were recorded on a proforma. RESULTS: There were 87 cases of peripartum hysterectomy (75 caesarean hysterectomies, 86.2% and 12 postpartum hysterectomies, 13.8%), making an incidence of 2.56/1000 deliveries. Most of the patients were para 3, 32 (36.8%), were mostly in age group of 35-39 years 38 (43.7%) and belonged to rural areas. Overall, the most common indication for emergency peripartum hysterectomy was morbidly adherent placenta with placenta previa 39(44.8%) followed by uterine rupture 24 (27.6%), uterine atony 13 (14.9%) and accidental haemorrhage 6 (6.9%). In 38 (43.7%) patients total abdominal hysterectomy was performed while 49 (56.3%) patients required subtotal hysterectomy. There were 9 (10.3%) maternal and 40 (46%) perinatal deaths; all were due to severity of conditions necessitating hysterectomy. CONCLUSION: Emergency peripartum hysterectomy is potentially a lifesaving procedure associated with significant maternal morbidity and mortality. Morbidly adherent placenta with placenta previa was the commonest indication for emergency peripartum hysterectomy. Previous scar, multiparity and abnormal placentation were the significant risk factors.

Incidence of Abdominal Hysterectomy Decreases with Increasing Surgical Volume

Incidence of Abdominal Hysterectomy Decreases with Increasing Surgical Volume

Clinical Cytology-Pathology Correlation for Diagnosis of Fallopian Tube Prolapse After Hysterectomy

Introduction: Prolapse of the fallopian tube into the vaginal vault is a rare complication that may occur after hysterectomy (incidence cited around 0.1%). The clinical presentation includes abdominal pain, dyspareunia, post coital bleeding, and/or vaginal discharge. However, some rare cases can be asymptomatic and diagnosed at routine checkup. Pap smears alone can sometimes be challenging and diagnosing fallopian tube prolapse …

Peripartum hysterectomy in a tertiary hospital in Western Sydney

The aim of this study was to review the incidence, indication, management and complications of peripartum hysterectomy (PH) in a tertiary level hospital over a decade. A retrospective review of all cases of PH performed at Westmead Hospital, Western Sydney, 2003–2012, was undertaken. PH was defined as hysterectomy performed after 20 weeks’ gestation or any time after delivery but within 6 weeks’ postpartum (Awan et al. 2011). There were 56 cases of peripartum hysterectomy of 46,177 births, a rate of 1.22 per 1,000 births. The most common indication for PH was morbid adherence of the placenta (58.2%) followed by uterine atony. Having a history of both caesarean section and placenta praevia is highly associated with a morbidly adherent placenta in the index pregnancy (p = 0.002). The most common complication was coagulopathy followed by febrile illness and urinary tract injury. Our data showed previous caesarean section and placenta praevia to be associated with abnormal placentation, the leading indication for PH. Since there is an association between a planned caesarean hysterectomy and reduced amount of estimated blood loss and blood transfused, the knowledge of placentation and adequate preoperative planning and consideration for elective hysterectomy could be beneficial. The morbidity associated with PH is considerable.

Developing a quantitative scoring system to assess the ‘clinical severity’ of the abnormally invasive placenta (AIP)

The incidence of peripartum hysterectomy (PH) shows fifty-fold variation worldwide (0.2–10.5/1000 deliveries) and risk factors include advancing maternal age and parity, previous caesarean section (CS) and abnormal placentation.In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend in PH incidence over 15 years since 1999; to assess risk of PH associated with morbidly adherent placenta (MAP), placenta praevia and postpartum haemorrhage (PPH) during 2005–2013; and to describe the causes, interventions and outcomes of PH cases during 2011–2013.For the 15-year time-trend analysis, PH cases and denominator data were extracted from Ireland’s Hospital In-Patient Enquiry database. Multivariate Poisson regression analysis assessed risk of PH associated with MAP, placenta praevia and PPH. In collaboration with the 20 Irish maternity units we carried out a three-year national clinical audit of severe maternity morbidity. PH was a notifiable morbidity and the audit included detailed review of MOH cases.In 1999–2013 there were 298 PH cases, a rate of 0.32/1000 deliveries. During the period 2005–2013, the PH rate was 50 times higher in deliveries involving PPH, 100 times higher with placenta praevia and 1000 times higher with MAP. During the clinical audit (2011–2013) there were 65 PH cases, a rate of 0.33/1000 deliveries, increasing with advancing age and parity. The reporting of abnormal placentation, primarily the co-occurrence of placenta praevia and MAP, was linked with previous CS. Fifty-six of the 65 cases suffered MOH, most commonly associated with placenta praevia, MAP and uterine atony. Prophylactic and therapeutic uterotonic agents were appropriately used in the majority of cases.The incidence of PH in Ireland has been consistently low over 15 years, averaging one case every 3000 deliveries. The recognised risk factors of MAP, placenta praevia and PPH were independently associated with PH, with MAP being by far the strongest predictor. The vast majority of PH cases in our clinical audit were associated with MOH. Some deficiencies were noted in antenatal care, in certain elements of treatment and clinical governance protocols but adherence to guidelines was generally high.

Ethnic and geographic variations in corpus uteri cancer burden: evidence based on data from 29 states and the District of Columbia. CI5 IX, X and SEER data (1998-2010).

To assess the pattern of corpus uteri cancer (CUC) in individual states of the USA according to ethnicity. Population-based cancer registries from 29 states and the District of Columbia with information on ethnicity for African-American women (AA) and Caucasian-American women (CA) were extracted from the Cancer Incidence in Five Continents (1998-2002, 2003-2007) and the Surveillance, Epidemiology, and End Results Program (SEER; 2008-2010) databases. Rate ratios (RRs) were calculated with respect to ethnicity, age, state, and region. In southern states, AA had a lower CUC burden among women aged <60years (AA/CA RR=0.67; 95% CI 0.64-0.70), whereas it was higher among women aged ≥60years (AA/CA RR=1.22; 95% CI 1.19-1.26). In other regions, the lower CUC burden among AA aged <60years was true in all states; however, the CUC burden among AA aged ≥60years was similar to that of CA. Data for the most recent period (2008-2010) indicate that the age-dependent crossover in CUC burden was not anymore restricted to the South, but also occurred in other regions. Overall, women in the South have had the lowest CUC burden compared with that in all other regions, irrespective of ethnicity and age. Significant geographic and ethnic variations in the CUC burden exist in the USA. The incidence of hysterectomy could be a factor underlying the geographic variations in CUC burden andparticular attention should be given to older AA in southern states.

Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period. We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.

Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy.

Background and Objectives:The goal of this study is to obtain updated surveillance statistics for hysterectomy procedures in the United States and identify factors associated with undergoing a minimally invasive approach to hysterectomy.Methods:A cross-sectional analysis of the 2009 United States Nationwide Inpatient Sample was performed. Subjects included all women aged 18 years or older who underwent hysterectomy of any type. Logistic regression and multivariate analyses were performed to assess the proportion of hysterectomies performed by various routes, as well as factors associated with undergoing minimally invasive surgery (laparoscopic, vaginal, or robotic).Results:A total of 479 814 hysterectomies were performed in the United States in 2009, 86.6% of which were performed for benign indications. Among the hysterectomies performed for benign indications, 56% were completed abdominally, 20.4% were performed laparoscopically, 18.8% were performed vaginally, and 4.5% were performed with robotic assistance. Factors associated with decreased odds of a minimally invasive hysterectomy included the following: minority race (P < .0001), fibroids (P < .0001), concomitant adnexal surgery (P < .0001), self-pay (P = .01) or Medicaid as insurer (P < .0001), and increased severity of illness (P < .0001). Factors associated with increased odds of a minimally invasive hysterectomy included the following: age >50 years (P < .0001), prolapse or menstrual disorder (P < .0001), median household income of $48 000–$62 999 (P = .007) or ≥$63 000 (P = .009), and location in the West (P = .02). A length of stay >1 day was most common in abdominal hysterectomy cases (96.1%), although total mean charges were highest for robotic cases ($38 161).Conclusion:The US hysterectomy incidence in 2009 decreased from prior years' reports, with an increasing frequency of laparoscopic and robotic approaches. Racial and socioeconomic factors influenced hysterectomy mode.

English

OBJECTIVES: To determine the incidence, risk factors, outcome, complications and the changing trends of indications for Emergency Peripartum Hysterectomy (E.P.H.), and compare the results with other reports in the literature. METHODS: A population based 5 year retrospective study of 72 cases of emergency peripartum hysterectomy was carried out using hospital database from January 2008 to December 2012 in a peripheral medical college of Eastern India. RESULTS: A total of 72 EPH were performed among 94276 deliveries with an incidence of 0.76/1000 deliveries. The incidence was more among multiparous women (69%) and highest in the age group of 20 to 29 years (77.7%). Ruptured uterus was most common indication for Emergency Peripartum Hysterectomy (52.7%).Maternal mortality was 11.11% following peripartum hysterectomy. Our study in eastern India shows a statistically significant lower incidence of peripartum hysterectomy compared to that in other parts of India (0.076% versus 0.35% deliveries; P value <0.0101). CONCLUSION: Emergency Peripartum Hysterectomy is a life saving procedure and often puts the obstetrician in a dilemma for decision making. In this rural and backward area of Eastern India, primary and post CS deliveries are associated with an increased risk of Emergency Peripartum Hysterectomy. These results are of particular concern considering the steady rise in post CS pregnancy particularly in this backward region of our country.

Peripartum hysterectomy: Two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa

Obstetric haemorrhage is the leading direct cause of maternal mortality in South Africa. To determine the incidence, indications, associations and maternal outcomes of emergency peripartum hysterectomies. A descriptive and retrospective analysis of patients who had peripartum hysterectomy between 1(st) February 2007 and 31(st) January 2009 in Nelson Mandela Academic Hospital at Mthatha city. The incidence of 0.95% of peripartum hysterectomies (n=63 or 9.5/1000 births) increased with the increasing maternal age from 0.121% at age of less than 20 years to 0.5% at age more or equal to 30 years. Similarly the incidence increased with parity from 0.332% for Primiparity to 0.468% at parity of four or more. The indications for the operation were uterine atony 19/63 (30.2%), secondary haemorrhage/puerperal sepsis 17/63 (27%) and ruptured uterus 16/63 (23.4%). The main intra operative complication was haemorrhage 13/63 (20.6%). Repeat laparotomy was done in 10/63 (15%) of patients due to haemorrhage. Admission to intensive care unit was 25/63 (39.7%). The case specific mortality rate was of 19 % (n=12). The main causes of death were hypovolaemic shock and septicemia. The incidence of peripartum hysterectomies was high and was associated with ruptured uterus and puerperal sepsis which are preventable.

Peripartum hysterectomy in 38 hospitals in China: a population-based study

To investigate the incidence, indications, risk factors and transfusions of peripartum hysterectomy in China. A population-based study was conducted using inpatient records of 38 hospitals between 1 January 2011 and 31 December 2011; multivariate logistic regression analysis was used to identify independent risk factors for peripartum hysterectomy. During the study period, there were 43 peripartum hysterectomy cases out of 114,420 deliveries (0.38‰). Abnormal placentation was major indication for peripartum hysterectomy. Several factors significantly increased the risk of peripartum hysterectomy in this population: placenta previa/accreta [adjusted odds ratio (aOR) 49.7, 95 % CI 25.0-98.9], maternal age ≥35 years (aOR 8.1, 95% CI 4.0-16.0), preeclampsia/eclampsia (aOR 7.5, 95% CI 2.6-21.7), cesarean delivery (aOR 3, 95% CI 1.1-8.0), and multiparity (aOR 2.7, 95% CI 1.2-5.4). In contrast, multiple gestations did not. Placenta previa/accreta, maternal age ≥35 years, preeclampsia/eclampsia, cesarean delivery and multiparity were risk factors of peripartum hysterectomy.

Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section

ObjectivePlacenta accreta, morbid adherence to the uterus to the myometrium, is commonest in association with placenta previa in women previously delivered by caesarean section (CS). It has become proportionally a greater cause of major maternal morbidity and mortality as the frequency of other serious obstetric complications has declined. The aim of this study was to examine the incidence of placenta accreta in the context of a rising caesarean delivery rate. Study designRetrospective review of the incidence of placenta accreta in parous women during the 36 years 1975–2010. Cases were identified from hospital records and then correlated with pathological reports. The incidence of placenta accreta was analysed in the context of women previously delivered by CS. ResultsDuring the 36-year period in our unit, 157,162 multiparous women delivered, of whom 15,151 (9.6%) had a previous CS scar. The institutional incidence of CS rose from 4.1% in 1975 to 20.7% in 2010. Twenty-five parous women, all with a previous CS, had placenta accreta requiring hysterectomy. The overall incidence of placenta accreta was 1.65 per 1000 parous women with a previous CS, but was low (1.06/1000) until 2002. From 2003 to 2010 the incidence rose to 2.37/1000 previous CS deliveries (OR 2.2; 95% CI 1.05–5.1). ConclusionThe frequency of placenta accreta correlated steadily with the CS rate until 2000. Since then, the incidence has nearly doubled in women with previous CS scars, suggesting an additional causative influence on risk.

Obstetric hysterectomy: Trend and outcome in Ile-Ife, Nigeria

Worldwide, the incidence of obstetric hysterectomy is expected to be on the decline due to improvements in obstetric care. This hospital-based 10-year review (2001–10) was performed to determine its incidence and outcome in Ile-Ife, Nigeria. The trend was determined by comparing the current incidence with that from two previous studies from the same centre. There were 58 obstetric hysterectomies and 15,194 deliveries during the review period, giving a rate of 3.8/1,000 deliveries. A rising trend was observed in the obstetric hysterectomy rate in Ile-Ife over two decades (1990–2010). Uterine rupture was the commonest indication (60%). Postoperative complications such as sepsis, vesico-vaginal fistula and renal failure affected 34.5% of the patients. Maternal and fetal case fatality rates were 18.2% and 43.6%, respectively. The obstetric hysterectomy rate in Ile-Ife is high and the trend is rising. Universal access to skilled birth attendance is advocated to reduce uterine rupture and consequently obstetric hysterectomy.