Risk Factors For Hysterectomy Research Articles

Prediction of cesarean hysterectomy in placenta previa complicated with prior cesarean: a retrospective study

BackgroundThe prevalence of both placenta previa and cesarean are on the rise. Multiple adverse outcomes are critically increased when placenta previa is subsequent to prior cesarean. The purpose of the present study is to develop a pre-surgical method for predicting adverse outcomes in pregnancy complicated with both placenta previa and prior cesarean.MethodsClinical data was obtained from the medical history system at the First Affiliated Hospital of Sun Yat-sen University from February 2003 to December 2016. All cases with a final diagnosis of “placenta previa/low lying placenta (ICD:O44.001-105)” and “scarred uterus complicated with pregnancy (ICD: O34.200-202)” were collected and reviewed. Hysterectomy was taken as the primary outcome; and blood loss was taken as the secondary outcome.ResultsOf 219 pregnant women in the final analysis, 25 received a hysterectomy following delivery, and 48 had blood loss exceeding 1000 ml. Pre-surgical risk factors for hysterectomy are ultrasonic signs of vascular lacunae, central placenta previa, and loss of normal hypoechoic retroplacental zone. A pre-surgical predictive equation referred to as “Hysterectomy Index in Placenta Previa with Prior cesarean (HIPs)” was generated and each risk factor was weighted to create an 8-point scale. This index yielded an area under the curve of 0.972 for the prediction of hysterectomy.ConclusionsApplication of the HIPs score may provide an effective pre-surgical prediction of cesarean hysterectomy in pregnant women complicated with both placenta previa and prior cesarean.

Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial

BackgroundPeripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas.MethodsWe used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis.ResultsFive percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7–3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6–5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9–1.7).ConclusionsPlacenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia.

Functional somatic syndromes as risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis

ObjectiveWe tested the hypothesis that functional somatic syndromes (FSSs) are risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis (BPS/IC). MethodsIn 312 women with incident BPS/IC, we diagnosed seven pre-BPS/IC syndromes: chronic pelvic pain (CPP), fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome (IBS), sicca syndrome, migraine, and panic disorder. Each was defined as present before 12months (existing syndrome) or onset within 12months (new syndrome) prior to BPS/IC onset. Retrospectively, we sought associations between prior hysterectomy and existing FSSs. Prospectively, we studied associations of existing and new syndromes with subsequent hysterectomy. Logistic regression analyses adjusted for age, race, menopause and education. ResultsThe retrospective study showed prior hysterectomy (N=63) to be associated with existing CPP and the presence of multiple existing FSSs. The prospective study revealed that 30/249 women with a uterus at baseline (12%) underwent hysterectomy in early BPS/IC. This procedure was associated with new CPP (OR 6.0; CI 2.0, 18.2), new IBS (OR 5.4; CI 1.3, 22.3), and ≥3 existing FSSs (OR 3.9; CI 1.1, 13.9). ConclusionAccounting for CPP and IBS, the presence of multiple FSSs (most without pelvic pain) was a separate, independent risk factor for hysterectomy in early BPS/IC. This suggests that patient features in addition to abdominopelvic abnormalities led to this procedure. Until other populations are assessed, a prudent approach to patients who are contemplating hysterectomy (and possibly other surgeries) for pain and who have IBS or numerous FSSs is first to try alternative therapies including treatment of the FSSs.

Post Ablation Pain and Postmenopausal Bleeding: Risk Factors for Hysterectomy after Endometrial Ablation

Post Ablation Pain and Postmenopausal Bleeding: Risk Factors for Hysterectomy after Endometrial Ablation

Risk factors for peripartum hysterectomy following uterine rupture

Objective: To investigate risk factors for hysterectomy following uterine rupture.Methods: A population-based study comparing all uterine ruptures with and without hysterectomy between 1988 and 2011 was conducted. Stratified analysis was performed using a multiple logistic regression analysis.Results: Peripartum hysterectomy complicated 20.7% (n = 34) of uterine ruptures during the study period (n = 164). Independent risk factors for hysterectomy following uterine rupture, from a multivariable logistic regression model, were relaparotomy (OR = 32.2, 95% CI = 2.5–421.9), extended tears involving the uterine cervix (OR = 6.1, 95% CI = 1.5–24.7), severe bleeding requiring packed cells transfusions (OR = 13.7, 95% CI = 3.2–58.5) and grand multiparity (≥5 deliveries, OR = 11.4 95% CI = 2.7–47.1).Conclusion: Hysterectomy is not common following uterine rupture. Independent risk factors for hysterectomy include relaparotomy, extended tears involving the uterine cervix, severe bleeding requiring packed cells transfusions and grand multiparity. Trained obstetricians should be involved in cases of uterine rupture and the possibility for conducting hysterectomy should be emphasized.

Endometrial Ablation: Is Tubal Ligation a Risk Factor for Hysterectomy

Endometrial Ablation: Is Tubal Ligation a Risk Factor for Hysterectomy

The efficacy of the levonorgestrel-releasing intrauterine system in perimenopausal women with menorrhagia or dysmenorrhea

To evaluate the hysterectomy rates and the risk factors for hysterectomy during the first 2years of use of a levonorgestrel-releasing intrauterine system (LNG-IUS) in perimenopausal women who had complaints of either menorrhagia or dysmenorrhea. One hundred ninety-two women over 40years old were retrospectively analyzed for a 2-year follow-up period. The changes in the amount and duration of bleeding and the pain scores were checked at 3, 6, 12 and 24months. Twenty-six (13.5%) women failed with LNG-IUS treatment and they received hysterectomy. Age, parity, the type of diseases, the amount of menstrual bleeding, the mean duration of persisted menorrhagia and the severity of pain before treatment were not the factors affecting removal of the LNG-IUS and undergoing hysterectomy. However, the pain score of the third month and the amount of bleeding on the sixth month were the factors affecting undergoing hysterectomy (P<0.05). When hysterectomy was performed, the average duration from LNG-IUS insertion to hysterectomy was 8.9months. The participants who persisted with the LNG-IUS treatment for 24months showed a success rate of 80.7%. LNG-IUS is an effective device for the treatment of perimenopausal women who have complaints of either menorrhagia or dysmenorrhea. Insufficient reduction of pain score during the first 3months and menstrual blood loss during the first 6months after insertion of the LNG-IUS were important factors that affected undergoing hysterectomy.

Long-term Impact and Risk Factors for Hysterectomy After Hysteroscopic Surgery for Menorrhagia

For women with menorrhagia, hysteroscopic resection of endometrial tissue, combined with myomectomy and polypectomy when indicated, offers an alternative to hysterectomy. Favorable short-term results have been documented, but the long-term outcome may be less impressive. This study examined long-term outcomes in 279 women with menorrhagia, seen consecutively in the years 1990-1999, who underwent hysteroscopic endometrial resection with or without myomectomy. Follow-up data were available for 259 women, 93% of those operated on, after a mean postoperative interval of 6 years. More than one-third of the women received hormonal therapy for endometrial suppression preoperatively. Operative complications occurred in 15 women, about 6% of the total group. Eight women with postoperative endometritis responded well to antibiotic therapy. Endometrial abnormalities were identified in 41% of cases. One-fourth of women had hysteroscopic resection of fibroids as well, and 9% had polypectomy. Late complications were recorded in nearly 8% of women who were followed up. A large majority of the 18 patients with hematometra had undergone tubal ligation. More than one-third of women had one or more gynecological procedures during follow-up, and 61 of them underwent hysterectomy. Indications for hysterectomy included, in order of declining frequency, myomas, adenomyosis, persistent menorrhagia or endometrial hyperplasia, and perioperative or postoperative complications. More than 80% of hysterectomies were done within 5 years after hysteroscopic surgery. On multivariate analysis, both past tubal ligation and a uterine cavity measuring 9 cm or more in length were associated with an increased risk of hysterectomy. Half of the women who did not require hysterectomy were amenorrheic on long-term follow-up, and none had more than slight menstrual bleeding. These findings show that hysteroscopic resection of endometrium and fibroids provide lasting benefit to women with menorrhagia and is a suitable alternative to hysterectomy. This approach may prove effective for women who have not been satisfied by use of a levonorgestrel-releasing intrauterine system.

Compliance with the published RCOG guidelines in women undergoing hysterectomy for menorrhagia in a district general hospital

SummaryThe Royal College of Obstetricians and Gynaecologists (RCOG) published guidelines describing the management of menorrhagia in primary and secondary care. In this study, we reviewed retrospectively, the compliance with these guidelines in women who underwent a hysterectomy for menorrhagia over a 3-year period in a District General Hospital. Case notes were reviewed for 22 women in whom the uterus was reported normal on histology. There was a high level of compliance in clinical assessment before hysterectomy. Nearly 70% of women received some form of medical treatment, however only 50% were offered endometrial ablation. Compliance was high in imparting information about the risk factors of hysterectomy and in administering thromboprophylaxis.

Long-term impact and risk factors for hysterectomy after hysteroscopic surgery for menorrhagia

The objective of this study was to assess the long-term impact of management and establish the incidence of hysterectomy, and to identify factors predictive of failure of the procedure among women who had undergone hysteroscopic endometrial resection with or without myomectomy for menorrhagia. Clinical history and data on additional treatment and follow-up status were obtained by medical record review and postal questionnaire for 279 women who had undergone hysteroscopic surgery. Follow-up data were available for 259 (93%) cases, and the mean follow-up was 6.0 years. Subsequent hysterectomy was the primary endpoint, and its incidence was calculated by survival analysis. Univariant analysis and Cox regression model were used to identify predictors of failure. Myomas, polyps, adenomyosis, or endometrial hyperplasia were found in 40.9% of hysteroscopic procedures. Perioperative complications occurred in 5.7% and late complications in 7.7%. During the follow-up period, 97 (37.5%) of 259 women underwent at least one gynecological procedure. The incidence of hysterectomy was 23.6% (95% confidence interval: 18.8–29.1%). Positive predictive factors for hysterectomy were long uterine cavity (≥9 cm) and tubal ligation. Most (82.8%) of the 198 women who did not undergo hysterectomy had postoperative oligo- or amenorrhea. Hormone replacement therapy was common (67%) among postmenopausal women after endometrial resection. Hysteroscopic resection of the endometrium and concomitant hysteroscopic resection of fibroids for the treatment of menorrhagia is a suitable alternative to hysterectomy and offers lasting results. A large uterine cavity indicating possible uterine pathology and tubal ligation associated with hematometra increase the risk of hysterectomy.

Previous Tubal Ligation Is a Risk Factor for Hysterectomy After Rollerball Endometrial Ablation

Previous Tubal Ligation Is a Risk Factor for Hysterectomy After Rollerball Endometrial Ablation

Previous Tubal Ligation Is a Risk Factor for Hysterectomy After Rollerball Endometrial Ablation

Previous Tubal Ligation Is a Risk Factor for Hysterectomy After Rollerball Endometrial Ablation

Previous Tubal Ligation Is a Risk Factor for Hysterectomy After Rollerball Endometrial Ablation

Although most women who undergo rollerball endometrial ablation for the treatment of menorrhagia are very satisfied with the outcome of their surgery, a consistent proportion of patients report continued or worsened symptoms, including pelvic pain and continued menorrhagia. Approximately 10% of women who have endometrial ablation eventually undergo hysterectomy to treat their symptoms. This study investigated the risk factors for failure of rollerball endometrial ablation. All women who underwent endometrial ablation for treatment of menorrhagia at the authors' institutions during the years 1990 to 2000 (N = 240; mean age = 43.1 years) were sent a questionnaire asking about their level of satisfaction with the surgery and any posttreatment problems or further surgeries. One hundred seventy-six (72%) of the 240 women responded and made up the study population. The average time from initial endometrial ablation to questionnaire was 49 months (range = 13-132 months). Seventy-four percent of women reported satisfaction with the outcome of their treatment, and 15% expressed dissatisfaction. Thirteen percent of subjects had either new or worse pelvic pain after treatment. Eleven women underwent a second endometrial ablation, 5 had additional laparoscopic pelvic surgery, and 21 (12%) eventually underwent a hysterectomy. Ninety (51%) of the 176 women who were treated with endometrial ablation had a tubal ligation, 80 of which had been done previously and 10 of which were performed concurrently with ablation. The women who had a tubal ligation were generally younger with a higher gravidity. Both groups reported similar degrees of pelvic pain before endometrial ablation (50%-54%), but women in the tubal ligation group had a higher rate of posttreatment continued (37% vs. 23%, P = .04) and new or worse (21% vs. 5%, P = .001) pelvic pain. They also had a higher rate of hysterectomies performed after endometrial ablation (17% vs. 7%, P = .05). When the results of the questionnaire were subjected to multivariate Cox proportional hazard analysis, tubal ligation was a risk factor for postablation hysterectomy (hazard ratio = 3.3, 95% CI = 1.1-9.7, P = .03) and new or worsened pain (hazard ratio = 3.2, 95% CI = 1.0-10.6, P = .05). In general, age did not predict the rate of hysterectomy or pain, except that women age 40 to 45 years had a greater degree of new pain (hazard ratio = 0.1, 95% CI = 0.01-1.0, P = .05), and women more than 45 years old reported new pain significantly less often than younger women. Increasing age was associated with decreased bleeding after ablation. Women in the youngest age group, less than 35 years, were the only group not likely to have significantly less bleeding after endometrial ablation.

Risk factors for hysterectomy among Mexican-American women in the US southwest.

The purpose of this study was to assess risk factors associated with a history of hysterectomy among Mexican-American women living in the United States Southwest. Mexican-American women ages 20-74 at time of interview were defined as a subpopulation among adults in the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-1984. Language preference, reproductive history, level of education, poverty status, generation of immigration, marital status, and insurance coverage were examined in relation to risk of hysterectomy using weighted tabulation and logistic regression for data resulting from complex survey designs. Heretofore, language preference has not been a variable considered in relation to risk of hysterectomy. In the HHANES, over 60% of women who spoke English most often rather than Spanish reported a history of hysterectomy. Women who had previously been pregnant were almost four times as likely (odds ratio 3.972) to have had a hysterectomy compared to women who had never been pregnant. Women who expressed any preference for English were twice as likely (odds ratio 2.050) to have had a hysterectomy than were those who responded that they exclusively preferred Spanish. Age, higher levels of education, and higher economic status also increased the risk of hysterectomy. In contrast, reproductive history, marital status, prior tubal ligation, generation of immigration, and health insurance did not have substantial effects on the risk of hysterectomy. This study suggests that, in the future, the effect of language preference should not be overlooked when considering risk factors for hysterectomy.

Tubal Ligation, Hysterectomy and D&C: Evidence from the Melbourne Women’s Midlife Health Project

The question of whether tubal ligation (TL) is associated with increased risk of hysterectomy or dilatation and curettage (D&C) is examined using data from a population-based study. Retrospective information on TL, D&C and hysterectomy was gathered from 1,810 Australian-born women aged 45–55 who were randomly selected from the population of Melbourne, Australia. Odds ratios for the outcomes were adjusted via logistic regression for age, years of education, smoking status, alcohol consumption, history of premenopausal complaints, number of lost pregnancies, and whether women have discussed menstruation or menopause with their doctor. With these variables taken into account, TL does not emerge as a risk factor for hysterectomy. Though there was a significant association between TL and the probability of ever experiencing a D&C, related extraneous variables which appear to link these events are identified.

Peripartum Hysterectomy: 10-Year Experience in Two Manitoba Tertiary Centers

The aim of the study was to review the incidence, associated risk factors, indications and complications of peripartum hysterectomy in the two teaching hospitals of the University of Manitoba, Canada. We conducted a retrospective study of all cases of peripartum hysterectomy that occurred over a 10-year period at the Health Sciences Centre (HSC), and over a five-year period at St. Boniface General Hospital (SBGH), the two tertiary centers in Winnipeg, Manitoba. Twenty-five peripartum hysterectomies were identified among 59,839 deliveries at both HSC and SBGH, for an overall incidence of 0.4/1000 births. Twenty-three hysterectomies (92%) were performed as emergency procedures, 19 (76%) followed a cesarean section (relative risk = 15), and 15 patients had single or multiple prior cesarean section scars (relative risk = 14.2). The indications for hysterectomy were: hemorrhage due to placenta/accreta (n=9); uterine atony (n=6); uterine rupture (n=5); retroperitoneal hematoma (n=2); and cervical laceration (n=1). Two cases were performed electively for cervical and ovarian cancer, respectively. Twenty-three women (92%) required blood transfusion, five (20%) had coagulopathy, four (16%) had bladder injuries, and three (12%) required salpingo-oophorectomy for uncontrolled adnexal bleeding. Our reported incidence for peripartum hysterectomy is lower than that reported elsewhere in the recent literature, while the risk factors for hysterectomy were similar to those reported. Although the maternal mortality was nil in this study, morbidity was high.