Indication For Emergency Peripartum Hysterectomy Research Articles

Conservative management of massive postpartum hemorrhage using the intrauterine balloon-an effective alternative to hysterectomy

THE INTRAUTERINE BALLOON-AN EFFECTIVE ALTERNATIVE TO HYSTERECTOMY SOHA SAID, FIONNUALA M. BREATHNACH, MICHAEL GEARY, FERGAL D. MALONE, Royal College of Surgeons in Ireland, Dublin, Ireland, Rotunda Hospital, Dublin, Ireland OBJECTIVE: To describe the role of the intrauterine balloon as an effective alternative to hysterectomy when faced with massive postpartum hemorrhage. STUDY DESIGN: All cases of massive postpartum hemorrhage requiring transfusion at a single large obstetric centre were reviewed. Information regarding demographic background, labor and delivery details, medical and surgical interventions, and outcome were recorded. RESULTS: During the study period from January 2005 to June 2006 there were 114 cases of massive postpartum hemorrhage requiring transfusion, out of cohort of 9,386 deliveries (1.2%). In 8 of thses cases (7%) the Rusch intrauterine balloon was used when medical management of uterine atony failed. Mean maternal age was 32 years (range 21-40) mean duration of labor was 4.5 hours (range 3-12), and 5 (63%) were multiparous. Mode of delivery was vaginal in 6 cases (75%), and cesarean in 2 (25%). Mean transfusion requirement was 6 units (range 3-15). In all 8 cases, hemorrhage was successfully controlled following placement of the balloon. Mean duration of the balloon placement was 7 hours (range 4-18). CONCLUSION: Massive postpartum hemorrhage due to uterine atony that fails to respond to medical treatment is amongst the most common indications for emergency peripartum hysterectomy. The use of an intrauterine inflated catheter balloon for tamponade is an effective conservative technique for controlling hemorrhage, is inexpensive, simple to use and is not associated with significant morbidity. The intrauterine balloon should be considered as an alternative to hysterectomy whenever medical management of uterine atony fails.

Emergency peripartum hysterectomy in a tertiary London hospital

The objective was to review all emergency peripartum hysterectomies performed at a tertiary hospital in London, UK, and to identify the risk factors for emergency peripartum hysterectomy. A retrospective case control study. The cases consisted of all women who had emergency peripartum hysterectomy between 1 January 1993 and 31 December 2003. Controls were women who delivered immediately before and after the indexed case. Demographic data, medical and surgical histories, pregnancy, intrapartum and postpartum data were collected. Differences between cases and controls were compared with chi2, Fisher exact and Student t tests. Multiple logistic regression analysis was performed to identify independent risk factors for emergency peripartum hysterectomy. There were 15 cases of emergency peripartum hysterectomy in 31,079 deliveries, giving a rate of 0.48 per 1,000. Women who had emergency peripartum hysterectomy were significantly older (mean age 37 years vs. 29 years, P<0.001) and multiparous (P=0.02). More of the cases had a history of uterine surgery (67 vs. 30%, P=0.01), placenta praevia (60 vs. 3%, P<0.0001) and were delivered by caesarean section (86.7 vs. 30%, P=0.003). Eighty percent of the hysterectomies were performed in the daytime and all were done by consultants. Haemorrhage due to placenta praevia was the main indication for emergency peripartum hysterectomy (47%). Independent risk factors for emergency peripartum hysterectomy were older age (odds ratios [OR] 1.2, 95% confidence interval [95% CI] 1.2-1.6), multiparity (OR 2.6, 95% CI 1.3-10.2), history of previous caesarean section (OR 13.5, 95% CI 2.7-65.4), caesarean delivery in index pregnancy (OR 11.6, 95% CI 2.1-68.6) and caesarean delivery in index pregnancy for placenta praevia (OR 18, 95% CI 3.6-69). Caesarean deliveries, especially repeat caesareans in women with placenta praevia, significantly increase the risk of emergency peripartum hysterectomy.

Indication of emergency peripartum hysterectomy: review of 17 cases.

The objectives were to determine the incidence, indications, associated risk factors and complications with emergency peripartum hysterectomy at King Abdulaziz University Hospital, Saudi Arabia. This is a retrospective analysis of 17 cases of emergency peripartum hysterectomy done from January 1, 1991 to December 31, 2002. Seventeen patients of emergency peripartum hysterectomy were identified among 34,379 deliveries and the incidence rate was 0.5 per 1,000. Uterine atony 11 (64.7%, 9 without previa and 2 with previa) and followed by morbid adherent placenta with previa 6 (35.3%, 1 complete placenta accreta and 5 partial adherent placenta) was the most common indication of hysterectomy. Of the atonic group, 3 were primigravidae, 2 of 3 induced and 1 placenta previa. In morbid adherent placenta group the gravidity, previous abortions and prior cesarean deliveries were higher compared to the atonic group and were statistically significant. Conservative surgery performed in 6 (35.3%) patients before proceeding to hysterectomies, 3 (17.7%) patients had uterine artery ligation and 3 (17.7%) internal iliac ligation. Eight (47.1%) hysterectomies were subtotal. Nine (53%) patients developed disseminated intravascular coagulopathy (DIC) and one case (6%) had bilateral ureteric ligation and bladder injury. No maternal deaths occurred. Uterine atony still is the leading cause of primary postpartum hemorrhage and the main indications of emergency peripartum hysterectomy. The combination of high parity, cesarean section, prior cesarean delivery and current placenta previa were identified as risk factors, and should alert the obstetrician that an emergency peripartum hysterectomy may needed. Although no maternal mortality occurred morbidity remained high.

Emergency peripartum hysterectomy: experience at a community teaching hospital

OBJECTIVES: To estimate the incidence, indications, risk factors, and complications associated with emergency peripartum hysterectomy at a community-based academic medical center. METHODS: We analyzed retrospectively 47 of 48 cases of emergency peripartum hysterectomy performed at Winthrop-University Hospital from 1991 to 1997. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 hours after delivery. Fisher exact test, Wilcoxon rank sum test, and Cochran-Armitage exact trend test were used for analysis. RESULTS: There were 48 emergency peripartum hysterectomies among 34,241 deliveries for a rate of 1.4 per 1000. Most frequent indications were placenta accreta (48.9%, 12 with previa, 11 without previa), uterine atony (29.8%), previa without accreta (8.5%), and uterine laceration (4.3%). Placenta accreta was the most common indication in multiparous women (58.8%, 20 of 34), uterine atony the most common in primiparas (69.2%, nine of 13). Twenty-two of 23 (95.6%) women with placenta accreta had a previous cesarean delivery or curettage. The number of cesarean deliveries or curettages increased the risk of placenta accreta proportionally. Thirty-eight (80.9%) of the hysterectomies were subtotal. Postoperative febrile morbidity was 34%; other morbidity was 26.3%. CONCLUSION: Placenta accreta has become the most common indication for emergency peripartum hysterectomy.