Postpartum Hysterectomy Research Articles

Dads in Distress: symptoms of depression and traumatic stress in fathers following poor fetal, neonatal, and maternal outcomes

BackgroundThis study aims to explore the prevalence of symptoms of depression and traumatic stress in fathers in the setting of poor fetal, neonatal, and maternal outcomes.MethodsA prospective mixed-methods study was conducted at an outer metropolitan public teaching hospital in Brisbane, Australia, with quantitative results presented here. Subjects included 28 fathers whose partners had experienced pregnancy or childbirth complicated by a significant congenital abnormality or aneuploidy, termination of pregnancy, fetal death in-utero, stillbirth, admission to the neonatal intensive care unit or special care nursery or significant maternal morbidity, such as a postpartum haemorrhage or an emergency postpartum hysterectomy. These experiences were classified into two groups: anticipatory (time to prepare) and sudden (no warning). The fathers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R) to assess subjective distress at 2-3 weeks (timepoint 1) and 3-4 months (timepoint 2) after the event.ResultsData for both the EPDS and IES-R scales was available for 26 fathers (92.9%) at timepoint 1 and for 15 fathers (53.6%) at timepoint 2. High overall EPDS scores (≥10) were noted in 16/27 (59.3%) fathers at timepoint 1 and 6/15 fathers (40.0%) at timepoint 2. High overall IES-R scores ≥33 were noted in 12/26 (46.2%) fathers at timepoint 1 and 4/15 fathers (26.7%) at timepoint 2. A higher percentage of fathers who experienced anticipatory events had EPDS and IES-R score above these cut-offs at timepoint 1 (8/13 or 61.5%) compared to those experiencing sudden events (8/14 or 57.1%), however, percentages were similar between groups at time point 2 (2/7 or 28.6%% and 4/8 or 50.0%, respectively). More fathers who experienced anticipatory events had IES-R scores ≥33 at timepoint 1 (7/13 or 53.8%) compared to those experiencing sudden events (5/14 or 38.0%).ConclusionOur study indicates high rates of distress in fathers exposed to poor fetal, neonatal, and maternal outcomes, which can persist for months after the event. Increased support for fathers in this setting may be required to prevent poor mental health. Further research on the long-term effects of these adverse events is warranted.

Postpartum Hemorrhage Trends and Outcomes in the United States, 2000-2019.

To analyze temporal trends in and risk factors for postpartum hemorrhage and to analyze the association of risk factors with postpartum hemorrhage-related interventions such as blood transfusion and peripartum hysterectomy. This repeated cross-sectional study analyzed delivery hospitalizations from 2000 to 2019 in the National (Nationwide) Inpatient Sample. Trends analyses were conducted using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Unadjusted and adjusted survey-weighted logistic regression models were performed to evaluate the relationship between postpartum hemorrhage risk factors and likelihood of 1) postpartum hemorrhage, 2) postpartum hemorrhage that requires blood transfusion, and 3) peripartum hysterectomy in the setting of postpartum hemorrhage, with unadjusted odds ratios and adjusted odds ratios with 95% CIs as measures of association. Of an estimated 76.7 million delivery hospitalizations, 2.3 million (3.0%) were complicated by postpartum hemorrhage. From 2000 to 2019, the rate of postpartum hemorrhage increased from 2.7% to 4.3% (AAPC 2.6%, 94% CI 1.7-3.5%). Over the study period, the proportion of deliveries to individuals with at least one postpartum hemorrhage risk factor increased from 18.6% to 26.9% (AAPC 1.9%, 95% CI 1.7-2.0%). Among deliveries complicated by postpartum hemorrhage, blood transfusions increased from 5.4% to 16.7% from 2000 to 2011 and then decreased from 16.7% to 12.6% from 2011 to 2019. Peripartum hysterectomy among hospitalized individuals with postpartum hemorrhage increased from 1.4% to 2.4% from 2000 to 2009, did not change significantly from 2009 to 2016, and then decreased significantly from 2.1% to 0.9% from 2016 to 2019 (AAPC -27.0%, 95% CI -35.2% to -17.6%). Risk factors associated with postpartum hemorrhage and transfusion and hysterectomy in the setting of postpartum hemorrhage included prior cesarean delivery with previa or placenta accreta, placenta previa without prior cesarean delivery, and antepartum hemorrhage or placental abruption. Postpartum hemorrhage and related risk factors increased over a 20-year period. Despite the increased postpartum hemorrhage rates, blood transfusions, and hysterectomy rates decreased in recent years.

Pregnancy and childbirth in women with bleeding disorders: A retrospective cohort study.

Reproductive-age women with bleeding disorders (BDs) are underdiagnosed and understudied, despite their increased risk for adverse health outcomes and pregnancy complications. This study examines pregnancy outcomes and obstetric complications of Utah women with BDs. This retrospective cohort study utilized linked birth records and clinical billing data from two large Utah healthcare systems. Utah residents who had their first birth at>20weeks gestation (2008-2015) and who received non-emergent care within either system before delivery were included (n=61 226). Multivariable logistic regression models were used to examine relationships between BDs and neonatal and obstetric outcomes. A total of 295 women (.48%) were included in the BD study population. Women with BDs had significantly increased odds of preterm birth (aOR 1.85, 95% CI 1.32-2.60), Caesarean delivery (aOR 1.38, 95% CI 1.06-1.79), postpartum blood transfusion (aOR 2.55, 95% CI 1.05-6.22), unplanned postpartum hysterectomy (aOR 33.96, 95% CI 7.30-157.89) and transfer to an intensive care unit (aOR 18.18, 95% CI 7.17-46.08). All of the women with BDs who experienced these serious complications were not diagnosed with a BD until the year of their first birth. Additionally, those with BDs were more likely to experience maternal and infant mortality. Women with BDs had an increased risk for preterm birth, Caesarean delivery, blood transfusion, unplanned hysterectomy, intensive care unit admission, maternal and infant mortality. Those who were not diagnosed with a BD before the year of their first birth were at an increased risk for serious pregnancy complications.

A Comparison Study Quantifying Environmental Impact of All Surgical Modalities of Hysterectomies

<h3>Study Objective</h3> Compare carbon dioxide emissions generated from operating room waste from all types of hysterectomies. Improving provider awareness on the environmental impact of hysterectomies may facilitate interventions to minimize our carbon footprint. <h3>Design</h3> A prospective cohort study was conducted, including patients who had a hysterectomy for any indication. Surgical waste in pounds (lbs), procedure data, and patient demographics was collected for each case. The formula below was used to identify the emissions generated for each procedure: <i>CO2 emissions = Waste in pounds (lbs) x 1 short ton/2000 lbs x EPA emission factor (kg CO2 per short ton) x global warming potential</i> <h3>Setting</h3> A 305-bed Level II Trauma center and academic teaching hospital, 11/2021 – present. <h3>Patients or Participants</h3> A total of 81 women ≥ 18 years of age underwent a scheduled hysterectomy (robotic assisted, laparoscopic, vaginal, abdominal) for benign or malignant indications at one institution. We excluded women < 18 years of age and emergent hysterectomies (i.e., postpartum hysterectomy). Data collection is ongoing with the goal of reaching a sample size of 100. <h3>Interventions</h3> Waste that was generated for every hysterectomy was weighed by the Primary Investigator. <h3>Measurements and Main Results</h3> Among the 81 cases analyzed, there was no significant difference between groups in age, ethnicity, and BMI. The total waste generated by each type of hysterectomy ranges from lowest (vaginal, 3 lbs.) to highest (robotic, 46 lbs.). CO2 emissions was significantly higher for robotic hysterectomies (57%, <0.0001) when compared to the other types. 100% of robotic hysterectomy waste contributed more than the mean CO2 emission of our sample. There was no significant association between duration of surgical case and amount of waste generated. Additional analysis in progress. <h3>Conclusion</h3> Robotic hysterectomies were found to generate a statistically significant majority of CO2 emissions. Additional studies are needed to determine the environmental impact and strategies to reduce our carbon footprint.

Obstructed labor and its effect on adverse maternal and fetal outcomes in Ethiopia: A systematic review and meta-analysis.

BackgroundObstructed labor is one of the five major causes of maternal mortality and morbidity in developing countries. In Ethiopia, it accounts for 19.1% of maternal death. The current review aimed to assess maternal and perinatal outcomes of obstructed labor in Ethiopia.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. A literature search was made using PubMed/MEDLINE, CINAHL, Summon country-specific search, and Cochrane Libraries’ online databases. Search terms were adverse outcome, obstructed labor, maternal outcome, fetal outcome, and Ethiopia. The Newcastle-Ottawa scale (NOS), based on a star scoring system, was used to assess the quality of the included studies. The meta-analysis was conducted using STATA 16 software. The pooled prevalence of an adverse maternal outcome, fetal outcome, and association between adverse outcome and obstructed labor was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias.ResultEighty-seven studies were included in this review, with an overall sample size of 104259 women and 4952 newborns. The pooled incidence of maternal death was estimated to be 14.4% [14.14 (6.91–21.37). The pooled prevalence of uterine rupture and maternal near-miss was 41.18% (95% CI: 19.83, 62.54) and 30.5% [30.5 (11.40, 49.59) respectively. Other complications such as postpartum hemorrhage, sepsis, obstetric fistula, hysterectomy, bladder injury, cesarean section, and labor abnormalities were also reported. The pooled prevalence of perinatal death was 26.4% (26.4 (95% CI 15.18, 37.7). In addition, the association of obstructed labor with stillbirth, perinatal asphyxia, and meconium-stained amniotic fluid was also demonstrated.ConclusionsIn Ethiopia, the incidence of perinatal and maternal mortality among pregnant women with obstructed labor was high. The rate of maternal death and maternal near miss reported in this review was higher than incidences reported from high-income and most low and middle-income countries. Uterine rupture, postpartum hemorrhage, sepsis, fistula, hysterectomy, and bladder injury were also commonly reported. To improve the health outcomes of obstructed labor, it is recommended to address the three delay models: enhancing communities’ health-seeking behavior, enhancing transportation for an obstetric emergency with different stakeholders, and strengthening the capacity of health facilities to handle obstetric emergencies.

Predicting Placenta Accreta Spectrum Disorders in a Cohort of Pregnant Patients in the North-East Region of Romania-Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging.

Background: Placenta accreta spectrum (PAS) disorders are associated with high mortality and morbidity due to postpartum hemorrhage, hysterectomy, and organ injury, and a multidisciplinary team is required for an individualized case management. In this study, we assessed the diagnostic and prognostic accuracy of the most important ultrasonographic (US) and magnetic resonance imagining (MRI) markers for PAS disorders. Material and Methods: The study included 39 adult pregnant patients with at least one previous cesarean delivery and both US and MRI investigations for placenta previa evaluated at the tertiary maternity hospital ‘Cuza Voda’, Iasi, between 2019 and 2021. The following US signs were evaluated: intra-placental lacunae, loss of the retroplacental hypoechoic zone, myometrial thinning < 1 mm, bladder wall interruption, placental bulging, bridging vessels, and the hypervascularity of the uterovesical or retroplacental space. The MRI signs that were evaluated were intra-placental dark T2 bands, placental bulging, loss of the retroplacental hypointense line on T2 images, myometrial thinning, bladder wall interruption, focal exophytic placental mass, and abnormal vascularization of the placental bed. Results: The US and MRI signs analyzed in our study presented adequate sensitivities and specificities for PAS, but no sign proved to be a useful predictor by itself. The presence of three or more US markers for accretion was associated with a sensitivity of 84.6.6% and a specificity of 92.3% (p < 0.001). The presence of three or more MRI signs supplemented these results and were associated with a sensitivity of 92.3% and a specificity of 61.5% for predicting PAS (p < 0.001). Moreover, US and MRI findings were correlated with FIGO grading and severity of PAS. Conclusions: Even though no US or MRI finding alone can predict PAS with high sensitivity and specificity, our study proves that the presence of three or more imagistic signs could significantly increase the diagnostic accuracy of this condition. Furthermore, US and MRI could be useful tools for evaluating prognostic and perinatal planning.

Birth during off-hours: Impact of time of birth, staff´s seniority, and unit volume on maternal adverse outcomes-a population-based cross-sectional study of 87 065 deliveries.

The aim of this study was to investigate whether time of birth, unit volume, and staff seniority impact the incidence of maternal complications in deliveries ≥34 + 0 gestational weeks. We conducted a population-based cross-sectional study of 87 065 deliveries occurring between 2004 and 2015 in ten public hospitals in Styria, Austria. A composite adverse maternal outcome measure of uterine atony, postpartum hysterectomy, postpartum bleeding, impaired wound healing, postpartum infections requiring antibiotic treatment, sepsis, or maternal death was used to compare outcomes by time of birth, unit volume, and staff seniority. Based on delivery data, generalized estimating equations (GEEs) were used to calculate the risk of maternal adverse outcomes. Maternal adverse events occurred in 1.33% of deliveries. Incidence of maternal adverse events was highest for units with >1000 deliveries (adjusted OR 1.40; CI 95%: 1.16-1.69) and higher for perinatal centers (adjusted OR 1.35; CI 95%: 1.15-1.57) compared with reference units (500-1000 deliveries/year). Delivery during the daytime compared with the afternoon and nighttime did not affect the incidence of maternal complications (P=0.765 and P=0.136, respectively). Compared with resident-guided deliveries, the odds ratio for an adverse event was the same when a consultant attended the delivery (adjusted OR 1.13; CI 95%: 0.98-1.30) but lower in deliveries managed by midwives only (adjusted OR 0.21; CI 95%: 0.07-0.64). Procedures performed during the night shift were not associated with increased complication rates. Delivery volume and high-volume centers were associated with the highest risk of maternal complications, and units with 500-1000 deliveries per year were the lowest. With increasing odds of pregnancy risks, these results change, and delivering in a high-volume center becomes at least as safe as delivering in a smaller unit.

Announcing the winner of the John J. Sciarra IJGO Prize Paper Award for 2021

The editors of the International Journal of Gynecology & Obstetrics (IJGO) are pleased to announce the winner of the prize paper award for the best clinical research paper from a low- or middle-income country published in IJGO during 2021. The winning paper is: Tang X, Guo C, Liu S, Guo J, Hua K and Qiu J. A novel prognostic nomogram utilizing the 2018 FIGO staging system for cervical cancer: A large multicenter study. Int J Gynecol Obstet 2021;155:86–94. https://doi.org/10.1002/ijgo.13644. It was published in the October 2021 issue of IJGO. This award brings with it a stipend of £800, a certificate of recognition, and complimentary access to IJGO for a period of 1 year from the date the prize is awarded. All clinical research articles submitted to the IJGO from low- and middle-income countries that were published in 2021 were considered for this prize. The paper was chosen from 95 qualifying articles. Selection and review were undertaken by the editors, and the Editorial Board of IJGO endorsed the decision. The winning paper by Tang et al. evaluated the prognostic performance of the revised 2018 FIGO staging system for cervical cancer in a multicentre study across four sites. In 3238 patients with cervical cancer, 1841 (almost 60%) were re-staged. Almost one third of these were re-staged due to tumor size, approximately 30% due to lymph node metastasis, and one third due to the inconsistency between the pre-operative and post-operative assessments. They concluded that the 2018 FIGO staging system was a better reflection of the survival of cervical cancer patients. This very important work also allowed the group to establish a nomogram that allowed them to predict the prognosis of cervical cancer more accurately. Additional papers that are worthy of special recognition are awarded an honorable mention. While the honorable mention recognition does not include a financial award, each author receives a certificate of recognition and a letter of commendation from the editors of IJGO. The IJGO Prize Paper Award was established in 1998 for the purpose of encouraging investigators, especially young scientists, from low- and middle-income countries to submit their best clinical research articles for publication in the journal. IJGO is the official publication of FIGO (International Federation of Gynecology and Obstetrics), the primary international organization for the specialty of obstetrics and gynecology. FIGO is dedicated to enhancing the health care of women worldwide. HONORABLE MENTIONS 2021 The following 11 papers receive an honorable mention: China Li Y, Wang H, Zhang Y, et al. Correlation between multi-type human papillomavirus infections and viral loads and the cervical pathological grade. Int J Gynecol Obstet. 2020;152:96–102. https://doi.org/10.1002/ijgo.13406 Wang X, Zhang C, Li X, Qi H, Liu Q, Lei J. Safety and efficacy of titrated oral misoprostol solution versus vaginal dinoprostone for induction of labor: a single-center randomized control trial. Int J Gynecol Obstet. 2021;154:436–443. https://doi.org/10.1002/ijgo.13546 Brazil Laporte M, Becerra A, Castro L, Veiga N Jr, Espejo-Arce X, Bahamondes L. Evaluation of clinical performance when intrauterine devices are inserted by different categories of healthcare professional. Int J Gynecol Obstet. 2021;152:196–201. https://doi.org/10.1002/ijgo.13396 Barbieri MM, Herculano TB, Dantas Silva A, Bahamondes L, Juliato CRT, Surita FG. Acceptability of ENG-releasing subdermal implants among postpartum Brazilian young women during the COVID-19 pandemic. Int J Gynecol Obstet. 2021;154:106–112. https://doi.org/10.1002/ijgo.13663 Turkey Karakas LA, Atilgan AO, Akilli H, Kuscu UE, Haberal A, Ayhan A. Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps. Int J Gynecol Obstet. 2021;152:433–438. https://doi.org/10.1002/ijgo.13448 Iran Ghotbizadeh Vhdani F, Nasiri Khormoji N, Eftekhar N, et al. A double-blind randomized trial on subendometrial injection of vasopressin to control bleeding in postpartum hysterectomy due to abnormally invasive placenta. Int J Gynecol Obstet. 2021;153:228–233. https://doi.org/10.1002/ijgo.13440 South Africa Budhram S, Vannevel V, Botha T, et al. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study. Int J Gynecol Obstet. 2021;155:455–465. https://doi.org/10.1002/ijgo.13917 Goldman B, Naidoo T. Formal training in cardiotocograph interpretation of healthcare practitioners improves interpretation: a prospective descriptive analytical study in a resource constrained setting. Int J Gynecol Obstet. 2021;153:527–532. https://doi.org/10.1002/ijgo.13513 Kenya Gwako GN, Obimbo MM, Gichangi PB, Kinuthia J, Gachuno OW, Were F. Association between obstetric and medical risk factors and stillbirths in a low-income urban setting. Int J Gynecol Obstet. 2021;154:331–336. https://doi.org/10.1002/ijgo.13528 Egypt Abdallah A, Khairy M, Tawfik M, et al. Role of first-trimester three-dimensional (3D) power Doppler of placental blood flow and 3D placental volume in early prediction of pre-eclampsia. Int J Gynecol Obstet. 2021;154:466–473. https://doi.org/10.1002/ijgo.13572 Malaysia Goh YP, Tan PC, Hong JGS, Sulaiman S, Omar, SZ. Combined massage and warm compress to the perineum during active second stage of labor in nulliparas: a randomized trial. Int J Gynecol Obstet. 2021;155:532–538. https://doi.org/10.1002/ijgo.13613

Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study.

Postpartum hemorrhage (PPH) is still one of the leading causes of maternal mortality worldwide. Recently effective PPH therapy with uterine packing with the chitosan-covered gauze was shown. This databased retrospective case-control study compares the therapy success of the chitosan tamponade with that of the balloon tamponade and medical therapy only. All women who delivered at a university hospital between May 2016 and May 2019 with PPH were included. Based on the applied therapy, women were divided into three groups: medical therapy only, balloon tamponade and chitosan tamponade. The groups were compared in terms of therapy success, side-effects and reasons for PPH. Primary outcome was the need for surgical/radiological measures including hysterectomy, secondary outcomes were differences in hemoglobin levels, duration of inpatient stay, admission to intensive care unit, number of administered blood products and inflammation parameters. A total of 666 women were included in the study. 530 received medical therapy only, 51 the balloon tamponade and 85 the chitosan tamponade. There were no significant differences in the need for surgical therapy, but a significantly lower number of hysterectomies in the chitosan tamponade group than in the balloon tamponade group. There were no relevant differences in secondary outcomes and no adverse events related to the chitosan tamponade. Since the introduction of chitosan tamponade, the number of PPH related hysterectomies dropped significantly by 77.8%. The chitosan tamponade is a promising treatment option for PPH. It reduces the postpartum hysterectomy rate without increased side effects compared to the balloon tamponade.

Transvaginally surgically treatment of early postpartum hemorrhage caused by lower uterine segment atony.

Prove the success of transvaginal hemostatic procedures in treatment of the early postpartum hemorrhage caused by lower uterine segment atony. We have conducted a retrospective, clinical study during a 10-year period (2010-2019) in our institution that is tertiary perinatal university center. This particular study enrolled total number of 29,543 deliveries with 215 cases of early postpartum hemorrhage (0.72%). Lower uterine segment atony was diagnosed in 44 cases (29.93%) in all uterine atony cases of early postpartum hemorrhage. Hemostatic ligation procedures according to authors: Losickaja in two cases, Hebisch-Huch in 13 cases, Habek in seven cases, Hebisch-Huch+Losickaja in 10 cases. According to our results, hemostatic ligation procedures alone (32 cases; 72.72%) or combined with gauze or ballon tamponade (five cases, 11.36%), have shown to be highly effective in 37 cases (84.09%). Lower uterine segment atony should definitely be identified and understood as a clinical entity. Transvaginal hemostatic approach for surgical treatment of lower uterine segment atony is accessible, minimally invasive, feasible, successful and lifesaving. All of the above-mentioned methods are of great importance in the prevention and treatment of obstetric shock, multiorgan failure, postpartum hysterectomy and finally vital for fertility preservation.

Burden of Placenta Previa as a Cause of Postpartum Hysterectomy at a Tertiary Care Hospital

Objective: To find the frequency of placenta previa in females undergoing hysterectomy during cesarean delivery at term. Material and methods: This Cross sectional study was conducted at Department of Obstetrics &amp; Gynecology, Lady Willingdon Hospital, Lahore for 6 months. Total 90 females who will fulfill selection criteria were enrolled in the study from operation theatre. Informed consent was obtained. Demographic features was obtained. Then females undergone cesarean section and planned hysterectomy. All surgeries were done by researcher herself. The location of placenta was noted ultrasound before cesarean and placenta previa was labeled if present. Location of placenta previa was also confirmed during cesarean section. Results: There were total 90 patients in our study among them the mean age was 36.61±4.31 years. There were 60(66.7%) women who underwent caesarean section previously. There were 12(13.3%) women with placenta previa. Frequency of placenta previa in different age groups was 41.7% in 30-34 years, 25% in 35-39 and 33.3% in women whose age was &gt;40 years. (p- value=0.71). No statistically significant association was seen between gestational age of women and placenta previa. i.e. (p-value-0.106) Gestational age 37-38: 25% (3/12) &amp; Gestational age 39-40: 75% (9/12). Statistically significant association was seen between parity status of women and placenta previa. i.e. (p-value-0.000) Parity-1: 0(0%), Parity-2: 0(0%), Parity-3:5(41.7%) and Parity-4:7(58.3%). No statistically significant association was seen between previous cesarean section of women and placenta previa. i.e. (p-value-0.366) No previous CS: 25% (3/12), One previous CS: 33.3% (4/12), Two previous CS: 16.7% (2/12) &amp; Three previous CS: 25% (3/12). Conclusion: High frequency of placenta previa was noted in our study among females undergoing postpartum hysterectomy. Keeping in mind the results of this study it can be concluded that the placenta previa being a risk factor for emergency obstetrics hysterectomy should be identified and screened antenatally to improve disease prognosis to achieve desired clinical outcomes. Key words: Placenta previa, Hysterectomy, Cesarean delivery, Term delivery

Effectiveness of emergency obstetric care training at the regional level in Ukraine: a non-randomized controlled trial

BackgroundEmergency obstetric care training, using Advances in Labour and Risk Management (ALARM) International Program (AIP) was implemented in Ukraine, a country with universal access to skilled perinatal and obstetric care but restricted resources. A total of 577 providers (65.5% of total) from 28 maternal clinics attended a 5-day training session focused on the five main causes of maternal mortality, with hands-on skill workshops, pre- and post- tests, and an objective structured clinical examination. The effects of this emergency obstetric care training on maternal outcomes is the subject of this paper.MethodsA non-randomized controlled trial was conducted. The pilot areas where the training was implemented consisted of 64 maternity clinics of which 28 were considered as cases and 36 non-participating clinics were the referents. Data on maternal outcomes were collected for a 2-year span (2004-2005) prior to the trainings, which took place 2006-2007 and again after implementation of the trainings, from 2008 to 2009. Information was collected from 189,852 deliveries. Outcomes for the study were incidences of operative delivery and postpartum hemorrhage. Non-parametric statistics, meta-analyses, and difference in difference (DID) estimation were used to assess the effect of the AIP on maternal indices.ResultsDID analysis showed that after the training, compared to the referents, the cases had significant reduction of blood transfusions (OR: 0.56; 95%CI: 0.48-0.65), plasma transfusions (OR: 0.70; 95%CI: 0.63-0.78), and uterus explorations (OR: 0.64; 95%CI: 0.59-0.69). We observed a non-significant reduction of postpartum hemorrhage ≥1000 ml (OR: 0.92; 95%CI: 0.81-1.04; P = 0.103). Utilization of vacuum extraction for vaginal delivery increased (OR: 2.86; 95%CI: 1.80-4.57), as well as forceps assisted delivery (OR: 1.80; 95%CI: 1.00-3.25) and cesarean section (OR: 1.11; 95%CI: 1.06-1.17). There was no change in the occurrence of postpartum hysterectomy and maternal mortality.ConclusionsAfter one week of Emergency Obstetrics Care training of the obstetric staff in a setting with universal access to perinatal and obstetric care but restricted resources, an association with the reduction of postpartum hemorrhage related interventions was observed. The effects on the use of vacuum extraction and cesarean section were minimal.Trial registrationRetrospectively registered 071212007807 from 07/12/2012.

Analysis of Indications and outcome of emergency obstetric hysterectomy

Introduction: Emergency hysterectomy is the surgical removal of the uterus following an unexpected and sudden event, which must be dealt with urgently by carrying out the procedure. When it is carried out in a woman with a pregnant uterus less than 24 hours after delivery, it is termed emergency peripartum hysterectomy. Peripartum Hysterectomy is an essential part of the obstetricians armamentarium. On one hand, it is the last resort to save a woman's life and on the other hand, her reproductive capability is sacrificed. Many times it is a very difficult decision and requires good clinical judgment.Objectives: To evaluate the indications, outcome and complications associated with peripartum hysterectomy procedures. Methods: A retrospective study of all cases of caesarean and postpartum hysterectomy between July 2019 and December 2020. Maternal characteristics, indications for hysterectomy and complications were reviewed.Results: The rate of peripartum hysterectomy was 1.32:1000 deliveries. Most were operative deliveries. The main indications were placenta accrete (36%), massive atonic PPH (32%) and uterine rupture (18%). Maternal morbidity was high and there were four maternal deaths (8%). All deaths were in patients brought in a critical condition to the hospital after massive blood loss.Conclusion: Peripartum hysterectomy is potentially a life saving procedure but the mortality and morbidity is high, especially if performed late when the hemodynamic instability has already set in.

MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY ASSOCIATED WITH ABRUPTIO PLACENTA

Background: Placental Abruption is an important cause of antepartum haemorrhage. It is defined as the separation of the placenta either partially or totally from its implantation site before delivery. APH is a major cause of maternal and perinatal morbidity and mortality. Therefore the study was planned to study the maternal and perinatal outcomes in patients of abruption placenta. Methods: The present study was conducted in the department of obstetrics and gynaecology, SMGS, Hospital, Govt. Medical College Jammu over a period of 1 year. It was a prospective study and all case of Abruptio placenta ≥ 28 weeks of gestational age were included. Results: It was observed that maximum cases of Abruptio Placenta i.e 67.65% were multigravida. 41.47% of cases of Abruptio Placenta had hypertension. 4.41 % had Polyhydramnios. 61.76% delivered vaginally. 23.53% patients had postpartum haemorrhage whereas only 2.98% had undergone Postpartum Hysterectomy. The most common fetal complication in Abruptio Placenta was prematurity (35.71%). 5.89% patients of Abruptio Placentas died during Peripartum period. Perinatal mortality was high 48.58%. Conclusions: Abruptio placent is associated with significant maternal and perinatal morbidity and mortality. Good regular antenatal care and availability of emergency medical services remains the backbone for the good maternal and perinatal outcomes.

Risk Factors for Adverse Maternal Outcomes following Expectantly Managed Preterm Prelabor Rupture of Membranes.

We sought to characterize the incidence and risk factors associated with developing maternal morbidity following preterm prelabor rupture of membranes. Retrospective case-control study of patients with preterm prelabor rupture of membranes at a single institution from 2013 to 2019 admitted at ≥23 weeks gestational age. The primary outcome was a composite of maternal morbidity which included: death, sepsis, intensive care unit (ICU) admission, acute kidney injury, postpartum dilation and curettage, postpartum hysterectomy, venous thromboembolism, postpartum hemorrhage, postpartum wound complication, postpartum endometritis, pelvic abscess, postpartum pneumonia, readmission, and/or need for blood transfusion were compared with patients without above morbidities. Severe morbidity was defined as: death, ICU admission, venous thromboembolism, acute kidney injury, postpartum hysterectomy, sepsis, and/or transfusion >2 units. Demographics, antenatal, and delivery characteristics were compared between patients with and without maternal morbidity. Bivariate statistics and regression models were used to compare outcomes and calculate adjusted odd ratios. Of 361 included patients, 64 patients (17.7%) experienced maternal morbidity and nine (2.5%) had severe morbidity. Patients who experienced maternal morbidity were significantly (p < 0.05) more likely to be older, have private insurance, have BMI ≥40, have chorioamnionitis at delivery, and undergo cesarean or operative vaginal delivery when compared with patients who did not experience morbidity. After controlling for confounders, cesarean delivery (aOR 2.38, 95% CI[1.30,4.39]), body mass index ≥40 at admission (aOR 2.54, 95% CI[1.12,5.79]), private insurance (aOR 3.08, 95% CI[1.54,6.16]), and tobacco use (aOR 3.43, 95% CI[1.58,7.48]) were associated with increased odds of maternal morbidity. In this cohort, maternal morbidity occurred in 17.7% of patients with preterm prelabor rupture of membranes. Private insurance, body mass index ≥40, tobacco use, and cesarean delivery were associated with higher odds of morbidity. These data can be used in counseling and to advocate for smoking cessation. · 17.7% of patients with PPROM experienced maternal morbidity.. · BMI ≥40 was associated with higher odds of maternal morbidity.. · Tobacco use and cesarean delivery were associated with higher odds of maternal morbidity..

Study on the application of King\u2019s combined uterine suture for hemostasis during cesarean section

IntroductionPostpartum hemorrhage is a serious complication of childbirth and is still the leading cause of maternal death worldwide. Lower uterine segment hemorrhage during cesarean section is an important cause of postpartum hemorrhage. Our objective is to expore the efficacy and safety of King’s combined uterine suture for hemostasis during cesarean section.MethodsWe examined 48 cases: 16 cases of pernicious placenta previa (including one case of twins), 11 cases of central placenta previa (including one case of twins), 18 cases of uterine scarring (including two cases of twins), as well as one case of twin pregnancy, two cases of breech presentation, and one case of pulmonary hypertension. The “King’s combined uterine suture” method for hemostasis was used in patients with lower uterine segment hemorrhage during cesarean section.ResultsThe results showed that all patients had successful hemostasis during surgery, and there were no cases of hysterectomy.ConclusionWe have concluded that King’s combined uterine suture is a fast and safe hemostasis method for cesarean section that can effectively reduce blood loss and restore the normal shape of the lower uterine segment. Furthermore, this suture method can reduce postpartum hemorrhage and hysterectomy rate, as well as improve maternal prognosis.

637Validation of anaemia, haemorrhage and blood disorder reporting in routinely collected hospital data

Abstract Background Blood and bleeding related conditions are reported in hospital administrative data, however the reliability of these data is unknown. Here we examine the reliability of reporting of conditions including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as transfusion and hysterectomy, in hospital records compared with obstetric databases. Methods Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Reporting in the hospital data, drawn from the Electronic Medical Records, was compared to that in linked obstetric data, obtained from the ObstetriX system, using obstetric data as the gold standard. Results 36,051 births were included. Sensitivity for anaemia and blood disorders was low (2.5–24.8%, positive predictive value (PPV) 12.0–82.6%), high for postpartum haemorrhage, transfusion and hysterectomy (82.8–96.0%, PPV 78.0–89.6%), and moderate for other obstetric haemorrhage (sensitivity: 41.9–65.1%, PPV: 50.0–56.8%) and placental complications (sensitivity 68.2–81.3%, PPV: 20.3–72.3%). Specificity and negative predictive values were high. Conclusions Anaemia and blood disorders are poorly reported in hospital data. Postpartum haemorrhage, transfusion and hysterectomy are well reported, while other obstetric haemorrhage and placental complications are moderately well reported. Key messages Hospital data may be a reliable source of information on postpartum haemorrhage, blood transfusion and hysterectomy. Caution is advised in the use of hospital data for studies of anaemia and blood disorders, and other sources should be sought where possible.

Prediction for Postpartum Hemorrhage of Placenta Previa Patients through MRI Using Self-Adaptive Edge Detection Algorithm.

The study aimed to explore the application value of MRI images based on the optimized self-adaptive edge detection algorithm in the diagnosis of placenta previa and in the prediction of postpartum hemorrhage. Specifically, a self-adaptive edge detection algorithm was constructed based on optimized edge operators, with the nearest scale parameters analyzed. It was then used to process the MRI images of 36 patients with placenta previa. MRI images of different types of placenta previa were analyzed. The results found that the placenta of the complete placenta previa was attached to the lower wall of the uterus and covered the internal cervix in U shape, and the placenta adhered to the anterior and lower wall of the uterus, with widespread placenta accreta noted. With the results of cesarean section as the standard, it was observed that 2 cases of complete placenta previa were diagnosed as partial placenta previa. The diagnostic accuracy rate was 94.44%, which was not notably different from the results of cesarean section (p > 0.05). The postpartum hemorrhage rate and hysterectomy rate of complete placenta previa were higher than partial placenta previa and marginal placenta previa, and the difference was notable (p < 0.05), but no notable differences were noted in placenta adhesion, placenta accreta, neonatal death, and neonatal asphyxia between the three types of placenta previa (p > 0.05). The incidence of thinned myometrium, placenta penetrating the cervix, placenta accreta, and uneven placental signal in patients with postpartum hemorrhage was higher versus those without postpartum hemorrhage, and the difference was notable (p < 0.05). In a word, MRI images based on the self-adaptive edge detection algorithm can clearly show the status of placenta previa and exhibit better diagnosis effects and a higher accuracy rate. The thinned myometrium, the placenta penetrating the cervix, placenta accreta, and uneven placental signal may be the related risk factors for postpartum hemorrhage in patients with placenta previa.

P-646 Pregnancy outcomes in women with panhypopituitarism - A population-based study

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p &amp;lt; 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p &amp;lt; 0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p &amp;lt; 0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p &amp;lt; 0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p &amp;lt; 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p = 0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p = 0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p = 0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78-1.97), gestational hypertension (95%CI:0.14-1.41), preeclampsia (95%CI:0.96-2.99), gestational diabetes (95%CI:0.30-1.01), preterm delivery (95%CI:0.74-1.91), preterm premature rupture of membranes (95%CI:0.17-2.82), operative vaginal delivery (95%CI: 0.23-1.19), small for gestational age neonates (95%CI:0.27-2.02) or intra-uterine fetal demise (95%CI:0.13-6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number not applicable

P–646 Pregnancy outcomes in women with panhypopituitarism - A population-based study

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p &amp;lt; 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p&amp;lt;0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p&amp;lt;0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p&amp;lt;0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p&amp;lt; 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p=0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p=0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p=0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78–1.97), gestational hypertension (95%CI:0.14–1.41), preeclampsia (95%CI:0.96–2.99), gestational diabetes (95%CI:0.30–1.01), preterm delivery (95%CI:0.74–1.91), preterm premature rupture of membranes (95%CI:0.17–2.82), operative vaginal delivery (95%CI:0.23–1.19), small for gestational age neonates (95%CI:0.27–2.02) or intra-uterine fetal demise (95%CI:0.13–6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings: Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number Not applicable