Objective: This study aimed to evaluate clinical characteristics and outcomes of complete uterine rupture during pregnancy and identify factors associated with adverse neonatal outcomes. Methods: This retrospective cohort study analyzed data from a single center between January 2008 and July 2024. Complete uterine rupture was defined as full-thickness myometrial and serosal rupture confirmed during surgery. Results: Among 50,185 deliveries, 22 cases of complete uterine rupture were identified (incidence: 0.044%). Most patients (86.4%) had a scarred uterus, exclusively due to previous myomectomy (n = 19). While abdominal pain was the primary symptom (72.7%), 22.7% of patients were asymptomatic. There were no cases of maternal mortality or peripartum hysterectomy. Of the 25 neonates, 12 (48%) experienced adverse outcomes, defined as NICU admission or perinatal death. Adverse neonatal outcomes were significantly associated with preterm delivery (p = 0.030), fetal heart rate abnormalities (p = 0.040), and a prolonged symptom-to-delivery interval (p = 0.032). Univariate analysis identified preterm delivery and abdominal pain as significant predictors of poor neonatal prognosis. Conclusions: Complete uterine rupture is a rare but critical obstetric emergency. Although maternal outcomes were favorable in this study, nearly half of the neonates experienced adverse outcomes. Preterm labor and abdominal pain serve as significant prognostic indicators. These findings emphasize that early clinical suspicion and minimizing the time from symptom detection to delivery are vital for optimizing neonatal survival and health.

Infertility Treatment is Associated with Peripartum Hysterectomy: A Population-Based Cross-Sectional Study.

Rising global incidence of peripartum hysterectomy, how to address this challenge? An invited review by the European Board and College of Obstetrics and Gynaecology (EBCOG).

Outcome of cesarean scar ectopic pregnancy continued to viability: Data from the International CSEP Registry.

The United States continues to experience increasing morbidity and mortality from opioid misuse with prescription opioids. Prescription opioids account for 32% of opioid related deaths. Cesarean delivery is the most common surgery among females. This makes this patient population directly at risk for opioid misuse as 75% of opioid prescriptions are filled after a cesarean delivery. Creating a plan for optimizing postpartum opioid pain control while limiting narcotic usage is a must. Primary objective was to identify an association of inpatient opioid use and post-discharge opioid consumption after cesarean delivery (CD). This prospective, observational study at a single academic tertiary hospital included patients undergoing CD between February to October of 2021. 142 patients met inclusion criteria with 110 (77%) patients completing the follow up phone call. Post-CD inpatient opioid consumption, discharge opioid prescription amount, and sociodemographics were recorded from the electronic medical record. Women with opioid use disorder, wound complication, peripartum hysterectomy, general anesthesia for delivery, or readmission for infection or surgery were excluded. Patients were then contacted by phone approximately two weeks post-discharge to assess the status of their opioid tablets and their subjective pain control. Opioid amounts were recorded as Oxycodone 5 milligram (mg) tablets. Primary outcome was the association between inpatient opioid use and post-discharge opioid consumption. Secondary outcomes included disposition of tablets at two weeks post-discharge. Outcomes were analyzed using multivariable logistic regression between quartiles of inpatient and post-discharge opioid consumption. After CD, inpatient opioid use predicted outpatient opioid use (r2 = 0.25; p < 0.001): patients in the highest quartile of inpatient use (≥ 13 tablets) consumed a mean of 16.6 tablets as inpatients and 13.1 tablets as outpatients. The lowest quartile of inpatient opioid users (≤ 5 tablets) consumed a mean of 1.0 tablet as inpatients and 1.7 tablets as outpatients (t = 18.1, p < 0.001 and t = 7.8, p < 0.001, respectively). 80/110 (73%) of patients had leftover opioids, with only 5 patients (6%) disposing of their tablets. The amount of tablets consumed post-CD as an inpatient is predictive of outpatient opioid consumption with minimal disposal of unused opioid tablets at two weeks post-discharge.

The New York State Safe Motherhood Initiative, a statewide quality-improvement effort, developed a bundle to optimize management of obstetric hemorrhage that was then disseminated and implemented by many hospitals in New York State. The purpose of this study was to evaluate trends in statewide outcomes related to postpartum hemorrhage (PPH) before, during, and after Safe Motherhood Initiative obstetric hemorrhage bundle implementation. Delivery hospitalizations in the 2007-2022 New York State Inpatient Database were analyzed for this repeated ecologic cross-sectional analysis that evaluated outcomes before and after implementation of the Safe Motherhood Initiative obstetric hemorrhage bundle from 2013 to 2015. The New York State Inpatient Database includes discharge data for all inpatient acute care hospitalizations in New York. Trends analysis of PPH diagnoses among all delivery hospitalizations over the study period was first performed. Then, among deliveries complicated by PPH, the rate of the following adverse outcomes was determined by year: 1) transfusion, 2) nontransfusion severe maternal morbidity (SMM), 3) disseminated intravascular coagulation (DIC), and 4) hysterectomy. Analyses were performed with joinpoint regression to determine the average annual percent change (AAPC). Adjusted logistic regression models were additionally performed for each of the adverse outcomes. Among 3,563,885 delivery hospitalizations, PPH increased continuously from 22 per 1,000 in 2007 to 59 per 1,000 in 2022 (AAPC 6.9%, 95% CI, 6.5-7.5%). In joinpoint analysis, transfusion among delivering patients with PPH increased from 192 per 1,000 in 2007 to 212 per 1,000 in 2013 (AAPC 2.1%, 95% CI, 0.6-6.6%) but then decreased to 174 per 1,000 in 2016 (AAPC -6.8%, 95% CI, -9.5% to -2.1%) before increasing again to 212 per 1,000 in 2022 (AAPC 2.8%, 95% CI, 1.2-8.1%). Severe maternal morbidity increased from 88 per 1,000 in 2007 to 122 per 1,000 in 2014 (AAPC 2.8%, 95% CI, 0.7-7.6%) before decreasing to 76 per 1,000 in 2017 (AAPC -16.3%, 95% CI, -20.8% to -8.4%) before rising again to 88 per 1,000 in 2022 (AAPC 4.4%, 95% CI, 0.1-18.5%). Disseminated intravascular coagulation increased from 54 per 1,000 in 2007 to 90 per 1,000 in 2014 (AAPC 4.5%, 95% CI, 1.3-12.6%), decreased to 53 per 1,000 in 2017 (AAPC -19.3%, 95% CI, -25.3% to -8.9%), and increased without a significant statistical association to 88 per 1,000 in 2022 (AAPC 4.2%, 95% CI, -2.0% to 24.5%). Hysterectomy decreased significantly from 26 per 1,000 in 2013 to 9 per 1,000 in 2022 (AAPC -10.2%, 95% CI, -14.3% to -8.7%). In logistic regression analysis, adjusted odds of severe morbidity from 2016 to 2022 were decreased compared with 2007 after accounting for patient- and hospital-level factors. The initiation of the New York Safe Motherhood Initiative obstetric hemorrhage bundle coincided with decreased risk for a range of adverse outcomes among deliveries complicated by PPH. Decreases in risk continued for approximately 3-4 years after initiation of the program for SMM, DIC, and transfusion. In comparison, hysterectomy decreased continuously until the end of the study period. Case mix and worsening comorbidity may have accounted for later study trends given that adjusted regression models for SMM demonstrated decreased odds of peripartum hysterectomy over the later portion of the study.

Peripartum hysterectomy in Taiwan: Trends, organizational accreditation, and volume effects.

From salvage hysterectomy to damage control: uterine artery ligation with tamponade for AFE with refractory hemorrhage in a 10-year analysis.

Impact of frozen embryo transfer on placenta accreta and institutional variations.

Placenta accreta spectrum (PAS) is a major obstetric emergency associated with massive hemorrhage, peripartum hysterectomy, and maternal morbidity. This study aimed to evaluate the diagnostic and prognostic value of platelet indices in PAS patients. A retrospective study was conducted at Ankara Etlik City Hospital between August 2022 and August 2024. A total of 200 pregnant women were divided into three groups: PAS (n = 63), placenta previa (n = 67), and controls (n = 70). Maternal demographics, delivery outcomes, neonatal parameters, and laboratory results were analyzed. Platelet indices-platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (P-LCR)-were obtained from first trimester and preoperative blood counts. Receiver operating characteristic (ROC) analysis determined predictive cut-off values. Multivariate logistic regression was performed to identify independent predictors of hysterectomy. First-trimester MPV < 10.45 demonstrated the highest discriminatory performance for predicting peripartum hysterectomy (AUC = 0.709, sensitivity 70.9%, specificity 71.4%). Third-trimester MPV, PDW, and P-LCR also showed moderate predictive value. First-trimester PDW > 12.75 predicted postpartum hemorrhage (AUC = 0.678), while PDW > 12.35 was associated with composite adverse neonatal outcomes (AUC = 0.597). In placenta previa patients, first-trimester PCT < 0.26 predicted PAS (AUC = 0.627). In multivariate analysis, only first-trimester MPV remained independently associated with hysterectomy (aOR 0.647, 95% CI 0.428-0.979; p = 0.040). Platelet indices show statistically significant but moderate associations with adverse outcomes in PAS. First-trimester MPV may serve as an early adjunctive marker in high-risk pregnancies; however, these parameters should not replace imaging modalities and require validation in prospective multicenter studies.

Introduction: Peripartum/postpartum hysterectomy is a rare but life-saving intervention for uncontrolled obstetric hemorrhage.Placenta accreta spectrum (PAS) and uterine atony are the most common indications; yet their clinical context and operative pathways may differ, particularly in centers where PAS is managed under urgent or emergent conditions.We evaluated indications, surgical management, and outcomes over a 10-year period and explored differences between uterine atony-related and PAS-related cases. Material and Methods:This retrospective, single-center study included women who underwent peripartum or postpartum hysterectomy for uncontrolled obstetric hemorrhage between January 2015 and June 2025.Cases were classified as uterine atony or PAS/placenta previa-related hemorrhage based on operative findings, clinical course, and pathology.Continuous variables were summarized as median [interquartile range (IQR)] and compared using the Mann-Whitney U test; categorical variables were compared using Fisher's exact test.Effect estimates with 95% confidence intervals (bootstrap for continuous variables) are provided in the tables; comparisons were exploratory.Results: Among 31,571 deliveries, 34 hemorrhage-related peripartum/postpartum hysterectomies were identified (incidence: 1.1 per 1,000 deliveries): 18 for uterine atony (52.9%) and 16 for PAS-related

Background:Placenta accreta spectrum (PAS) is a leading cause of obstetric morbidity and peripartum hysterectomy. Rising cesarean delivery rates, advanced maternal age, and assisted reproductive technologies have increased its incidence. Early, standardized diagnosis is essential for multidisciplinary planning and improved outcomes, yet formal screening guidelines are lacking.Objective:To raise awareness of the importance of antenatal screening for PAS, summarize key clinical and imaging risk factors, and propose a standardized mid-trimester ultrasound protocol for high-risk patients.Methods:An expert panel convened under the Pan-American Society for the Placenta Accreta Spectrum (PAS2) reviewed available evidence, risk stratification models, and prior consensus statements to develop practical recommendations for PAS screening.Results:PAS risk rises with the number of prior cesarean deliveries, especially in the setting of concurrent placenta previa or anterior low-lying placenta. Combined transabdominal and transvaginal ultrasound using grayscale and low-flow color Doppler (<10 cm/s) best identifies characteristic markers such as loss of the clear zone, myometrial thinning, bladder-wall interruption, placental bulge, uterovesical hypervascularity, lacunae, and bridging vessels. Standardized imaging protocols and structured reporting improve detection and facilitate referral to specialized centers.Conclusions:All patients with placenta previa or low-lying placenta and prior cesarean delivery should undergo targeted PAS screening at the time of anatomic survey. Early, systematic assessment and referral improve safety and outcomes.

Classical ultrasound signs of placenta accreta spectrum (PAS) at birth, including anomalies of the lower uterine segment (LUS) and uteroplacental and intraplacental circulations, are now well established. The purpose of this study was to evaluate the use of "intracervical lakes" and "the rail sign," which are more recently described signs. We conducted a retrospective analysis of ultrasound imaging data and primary surgical outcomes of consecutive singleton pregnancies in patients with a history of at least one prior CD presenting with an anterior low-lying or placenta previa at 32-36 weeks. Ultrasound findings were recorded using a standardized protocol. The diagnosis of PAS was confirmed when one or more placental lobules could not be digitally separated from the uterine wall at delivery or during the gross examination of hysterectomy or partial myometrial resection (PMR) specimens, and confirmed by histopathology. All analyses were performed using a logistic regression. Of the 227 patients in the cohort, 50 (22%) presented with intracervical lakes on transvaginal scan (TVS) and 97 (47.7%) with a rail sign on transabdominal sonography (TAS). A peripartum hysterectomy (PH) was performed in 116 cases (51%), and 97 patients were managed conservatively: 41 (18%) with PMR and LUS reconstruction, and 70 (31%) with a complex CD, with no intraoperative evidence of PAS. Placental lacunae were the strongest predictors of both PAS and PH, with a high lacunae score (3+) associated with odds ratios (ORs) of 320 (95% confidence interval (CI) 243,4231) for PAS and 9.00 (95% CI 3.01,26.9) for PH, respectively. Associations with PAS were also found for placental bulge (OR 8.24; 95% CI 2.54,26.8) and the rail sign (OR 3.01; 95% CI 1.04,8.67). Increased odds of PH were found for myometrial thinning of < 1mm (OR 5.47; 95% CI 1.69,17.7) and the presence of intracervical lakes (OR 12.3; 95%CI 3.89,39.1). The presence of a rail sign was associated with an increased odds of PAS at birth, whereas the presence of intracervical lakes was associated with an increased odds of peripartum hysterectomy in patients with a history of CD who presented with a placenta previa. This study was prospectively registered. Ethical approval was obtained before the start of this study (Scientific and Research Ethical Committee approval at the University of Cairo, RSEC 021001). The study was conducted in accordance with the Declaration of Helsinki.

Background: Emergency peripartum hysterectomy (EPH) is a life-saving procedure performed to control intractable obstetric hemorrhage. The incidence and indications have evolved over time, necessitating contemporary analysis. Objective: To analyze the incidence, risk factors, indications, and fetomaternal outcomes of peripartum hysterectomy at a tertiary care hospital in South India. Methods: A prospective observational study was conducted at Government Raja Mirasudhar Hospital, Thanjavur for a period of 12 months. All cases of peripartum hysterectomy were analyzed for demographic characteristics, indications, risk factors, surgical details, and maternal and neonatal outcomes. Results: Among 18,527 deliveries, 46 peripartum hysterectomies were performed, yielding an incidence of 2.5 per 1,000 deliveries (0.2%). The incidence was higher following cesarean section (4.8/1000) compared to vaginal delivery (0.7/1000). The majority of women (71.7%) were aged 25-34 years, and 89.1% were multiparous. Abnormally invasive placenta was the leading indication (60.9%), followed by intractable atonic postpartum hemorrhage (32.6%). Major risk factors included multiparity (89.1%), previous cesarean sections (82.9%), and placenta previa (60.9%). Maternal complications included coagulopathy (28.3%), febrile episodes (26.1%), and acute kidney injury (23.9%). Maternal mortality was 4.3%, and perinatal mortality was 12.8%. Conclusion: The incidence of peripartum hysterectomy remains significant, with abnormally invasive placenta being the predominant indication. Previous cesarean sections emerged as a major risk factor, highlighting the importance of judicious use of primary cesarean delivery.

Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence. Variation in surgical management and limited multidisciplinary involvement may contribute to adverse maternal outcomes. To evaluate whether the implementation of a multidisciplinary team (MDT) protocol for PAS was associated with improved perioperative outcomes. This retrospective cohort study included 417 women diagnosed with PAS from 2011 to 2022 at a tertiary center. In 2019, a structured MDT protocol was adopted, incorporating standardized imaging, preoperative conference, routine bilateral ureteral catheter (UC) placement, and on-site urologic support. Outcomes of MDT-managed patients (n = 108) were compared with pre-MDT patients (n = 309). Multivariable logistic regression and generalized linear models adjusted for maternal age, gravidity, prior cesarean delivery, placenta previa, PAS grade, surgical urgency, gestational age, and year of delivery. After adjustment, MDT care was associated with lower odds of urologic injury (aOR 0.34; 95% CI 0.12-0.82), surgical complications (aOR 0.39; 95% CI 0.18-0.78), transfusion (aOR 0.41; 95% CI 0.14-0.93), and hysterectomy (aOR 0.22; 95% CI 0.05-0.91). Adjusted estimated blood loss decreased by 260mL (95% CI - 480 to - 70), and length of stay was reduced by 0.9days (95% CI - 1.4 to - 0.3). Results remained consistent in sensitivity analyses limited to 2017-2022. Implementation of an MDT protocol was associated with reduced perioperative morbidity, supporting multidisciplinary management as a potentially safer strategy for high-risk PAS surgery.

Placenta accreta spectrum (PAS) refers to a group of obstetric complications characterized by abnormal adherence of the placenta to the uterine wall. Worldwide, the prevalence of PAS is increasing, due to the trend of rising caesarean deliveries. We report here a series of 6 cases of placenta accreta that were initially presented to the hospital with bleeding per vagina, abnormal placental position, or invasion on an ultrasound scan Despite having definitive grounds for an emergency lower segment caesarean section (LSCS), the majority of the patients had peripartum hysterectomy. The findings on the ultrasound were subsequently confirmed during surgery and supported by a histological analysis. Peripartum hysterectomy remains the lifesaving procedure over conservative methods for post-partum hemorrhage (PPH) secondary to abnormal placental invasion.

Background: Placenta Previa (PP) is a significant cause of maternal and fetal morbidity and mortality, especially in patients with scared uterus. This study aimed to compare the maternal and neonatal outcomes of PP with and without coverage of a uterine scar in a tertiary hospital in Chattogram, Bangladesh. Materials and methods: A prospective observational study was conducted from January 2024 to June 2024 in Chittagong Medical College Hospital. Consecutively admitted 38 singleton pregnancies with PP with a history of Cesarean Section (CS) or myomectomy were included and divided into two groups: the PP with coverage of a uterine scar group (PPCS group) and the PP without coverage of a uterine group (Non-PPCS group). Maternal and neonatal outcomes between two groups were compared by statistical methods. Results: There were 38 patients with with PP on scared uterus and were further classified into two groups: PPCS (n=23) and Non-PPCS (n=18). Both the groups were comparable in terms of their baseline sociodemographic and clinical characteristics. Placenta accreta spectrum was (95.7% vs. 20%.0, p&lt;0.001), hemorrgage (91.3% vs. 46.7%, p=0.006), urinary bladder injury (26.7% vs. 0%, p=0.031), peripartum hysterectomy (65.2% vs. 6.7%, p=0.001), ligation of uterine artery (56.5% vs. 93.3%, p=0.014) and use of uterine compression suture (30.4% vs. 66.7%, p=0.028) had a significant difference between PPCS group and Non-PPCS group. Neonatal outcomes in terms of prematurity, low birth weight, low APGAR score, need for NICU admission, and perinatal death were similar between two groups. Conclusion: The PPCS group had poorer maternal outcomes than the Non-PPCS group. To counsel their patients appropriately, healthcare providers should be aware of possible complications of placenta previa lying over the uterine scar. Chatt Maa Shi Hosp Med Coll J; Vol.24 (1); Jan 2025; Page 33-36

Outcome of supracervical compared to total hysterectomy for emergency peripartum hemorrhage: a systematic review and meta-analysis.

Background: Antepartum Hemorrhage (APH) is a terrible obstetric emergency associated with maternal and fetal morbidity and mortality worldwide. Objective of this study was to asses the maternal and fetal outcomes as well as to formulate the preventive measures for reducing maternal and fetal complications in patients with APH. Materials and methods: This prospective observational study was conducted at Chattagram Maa-O-Shishu Hospital Medical College, from January to December 2021, on all admitted pregnant women with APH more than 28 weeks gestation. Detailed history, clinical examination, associated conditions, mode of delivery, fetal conditions and investigations were analyzed. Results : A total of 113 APH Cases were reported amongst 5724 pregnant women with its incidence about 2%. The most common cause of APH was placenta previa 80(70.8%) followed by abruptio placenta 28 (24.8%), unexplained 3 (2.7%) and local 2(1.7%) causes. APH was found commonly in patients 72(64%) with age group between 26-30 years, multigravida 95(84%), pregnancy induced hypertension 36 (PIH 32%) previous history of caesarean section 34(30%) and curettage 22(19.2%). Most of the cases 83 (73.5%) were terminated at 34-36 weeks of gestation. There was 1( 0.9%) maternal mortality. However, pregnancy complications were remarkably higher, most common maternal complications were postpartum hemorrhage 45(40%) and maternal shock 6 (5.1%). The commonest mode of delivery was caesarean section 83(73.5%) and in 1(0.9%) case peripartum hysterectomy was needed. Perinatal complications were prematurity 94 (83.1%), perinatal asphyxia 51(45%), stillbirth 26( 23%) and most common causes of early neonatal death were prematurity and neonatal sepsis. Conclusions: APH is associated with significant maternal and fetal morbidity as well as mortality which could be reduced by regular antenatal care, early detection and early referral to higher centers. Better facilities for caesarean section, availability of blood bank and multidisciplinary approach with a good NICU can improve maternal and fetal outcome of APH patients. The incidence of fetal mortality due to abruptio placenta still remains high. Chatt Maa Shi Hosp Med Coll J; Vol.24 (1); Jan 2025; Page 57-62

Background: Peripartum hysterectomy (PH) is among the most challenging and life-saving obstetric procedures, conducted as a last resort in catastrophic obstetric emergencies, primarily involving severe postpartum hemorrhage and placenta accrete spectrum (PAS). With the increasing rates of cesarean sections, the incidence of PAS related complications and emergency hysterectomy is concurrently rising. It is imperative to assess its burden, indications, and outcomes to enhance obstetric care and inform preventive strategies in resource-constrained settings. Aim: To evaluate the incidence, clinical presentation, indications, risk factors, maternal and neonatal outcomes, and associated factors among women who underwent peripartum hysterectomy at a tertiary care obstetric centre of central India. Materials and Methods: A retrospective observational study was conducted after obtaining approval from the Institutional Ethics Committee and included all women who underwent peripartum hysterectomy at our tertiary care centre between January 2025 and December 2025. Demographic characteristics, obstetric history, indications for hysterectomy,transfusion requirements,intraoperative findings,maternal, and neonatal outcomes were analysed descriptively.