Risk Of Peripartum Hysterectomy Research Articles

Mode of Delivery and Obstetric Complications in the Setting of Prior Uterine Surgery.

This study aimed to evaluate cesarean rates and risk for obstetric complications among deliveries with a history of prior uterine surgery. This serial cross-sectional study analyzed deliveries with and without prior uterine surgery in the 2016-2019 Nationwide Inpatient Sample. Unadjusted and adjusted logistic regression models were performed to assess risk of nontransfusion severe maternal morbidity (SMM) and other obstetric complications based on the presence or absence of prior uterine surgery with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association. Adjusted models accounted for demographic, hospital, and delivery factors. Demographics and clinical factors among deliveries with and without a prior history of uterine surgery diagnosis were compared with the chi-square test with p < 0.05 considered statistically significant. Of 14.7 million delivery hospitalization identified, 6,910 (4.7 per 10,000) had a history of uterine surgery and 111,710 (0.76%) experienced SMM. Women with prior uterine surgery were more likely to be older, to be of unknown race or ethnicity, and to have private insurance (p < 0.01 for all). Eighty-five percent of deliveries with prior uterine surgery were performed by cesarean compared with 32% of deliveries without prior uterine surgery (p < 0.01). In adjusted analysis, compared with patients without prior uterine surgery, patients with prior uterine surgery were not at increased risk for SMM (aOR 1.23, 95% CI 0.73-2.07). Evaluating obstetric complications, patients with prior uterine surgery had a decreased risk of postpartum hemorrhage (aOR 0.64, 95% CI 0.43-0.96) and an increased risk of peripartum hysterectomy (aOR 4.12, 95% CI 1.75-9.67), and no difference in other obstetric complications assessed. These findings suggest that current clinical practice results in similar delivery risks among patients with compared with without prior uterine surgery. · Risk for most adverse outcomes is similar among patients with prior uterine surgery.. · Risk for peripartum hysterectomy was higher with prior uterine surgery.. · Risk for SMM was not higher with prior uterine surgery..

Incidence of Peripartum Hysterectomy in High Risk Patients at Aziz Bhatti Shaheed Hospital Gujrat

Objective: The aim of this study is to identify the association as well as the incidence of peripartum hysterectomy in high-risk patients. Methods. This study was conducted at Aziz Bhatti Shaheed Hospital Gujrat, Pakistan from 1 January 2018 to 31 December 2021. Data of 200 cases of peripartum hysterectomy collected that were done at the hospital during the study duration were the part of the study. The participant was randomly selected and their data was stumbled through the medical history of patients obtained by the hospital staff before the treatment and during treatment. Various maternal characteristics as age, education level, number of previous births smoking, and material status were obtained through medical Performa. Main risk factors included abnormal placentation, uterine rupture, hemorrhagic factors, Delivery methods, and multiple gestations were determined. Adjusted odds ratios OR were measured the association of risk factors with peripartum hysterectomy through the stratified analysis. Confidence intervals for the incidence rates were based on the Poisson distribution for a count of 100 or less. Results: Vaginal delivery had less risk of peripartum hysterectomy with OR (95% CL) = 3.5 (1.4-3.5) in 20 (10%) patients. Twist risk was found in 40 (20.0%) patients who had Vaginal delivery after cesarean with OR (95% CL) = 6.1 (4.1-5.9). Higher risk was measured in patients with cesarean delivery OR (95% CL) = 6.8 (4.8-10.6) and repeated cesarean OR (95% CL) 33 (17.0-78.0). So, we measured the highest incidence of peripartum hysterectomy in repeated cesarean cases. Patients with placental abnormality were strongly associated with peripartum hysterectomy. 71 (35.5%) patients with adherent placenta, OR (95% CL) = 22 (14.0-57.2) had highest association with peripartum hysterectomy. Its incidence rate is 22 fold greater than placenta previa and placenta abruption. As 48 (24.00%) patients were found with Placenta Previa, OR (95% CL) = 6.3 (3.3-10.4) and 20 (10.0%) patients were found with Placental abruption, OR (95% CL) = 4.1 (1.6-4.5). Conclusion: eventually, we found placental abnormalities are the most critical situation had a strong association with peripartum hysterectomy especially adherent placenta. This shows the highest value of confidence intervals that indicates its higher incidence rate among the other factors. Keywords: peripartum hysterectomy, adherent placenta, placenta previa

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.

Risk of peripartum hysterectomy in births after assisted reproductive technology

To investigate whether women who conceive after assisted reproductive technology (ART) are at higher risk for emergency peripartum hysterectomy. A case-control study using a prospectively maintained institutional database. A tertiary referral university teaching maternity hospital. Thirty-one women who underwent peripartum hysterectomy for management of hemorrhage, and 19,902 control women. None. Association between potential predictors and peripartum hysterectomy. The incidence of peripartum hysterectomy was 1.7 cases per 1,000 births (95% confidence interval [CI] 1.2-2.4). After adjustment for maternal age and twin pregnancy, placenta previa (odds ratio [OR] 50.78, 95% CI 23.30-110.68), prior cesarean delivery (OR 6.72, 95% CI 2.99-15.09 for one cesarean; OR 6.80, 95% CI 1.45-31.90 for two or more cesareans), previous myomectomy (OR 24.59, 95% CI 6.70-90.19), and ART conception (OR 5.98, 95% CI 2.18-16.40) were all antenatal predictors for peripartum hysterectomy. In women having a peripartum hysterectomy, 13.4% of the risk is attributable to mode of conception. A history of ART increases the likelihood of needing a peripartum hysterectomy to control hemorrhage. Further investigation is needed to determine whether ART conception should be included in algorithms of risk stratification for emergency cesarean hysterectomy and plan of care be modified accordingly.

Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study.

To estimate the incidence of emergency peripartum hysterectomy over 6 years in Ain-shams University Maternity Hospital. Detailed chart review of all cases of emergency peripartum hysterectomy, 2003-2008, including previous obstetric history, details of the index pregnancy, indications for emergency peripartum hysterectomy, outcome of the hysterectomy and infant morbidity. The overall rate of emergency peripartum hysterectomy was 149 of 66,306 or 2.24 per 1,000 deliveries. The primary indications for hysterectomies were placenta accreta/increta 59 (39.6 %), uterine atony 37 (24.8 %), uterine rupture 35 (23.5 %) and placenta previa without accreta 18 (12.1 %). After hysterectomy, 115 (77 %) women were admitted to the intensive care unit. Women were discharged home after a mean 11.2 day length of stay. Using multifactorial logistic regression analysis, we found that woman's age, atonic uterus, placenta accreta/increta, previous cesarian section and ruptured uterus were independent predictors for peripartum hysterectomy Abnormal placentation was the main indication for peripartum hysterectomy. The risk factors for peripartum hysterectomy were morbid adherence of placentae in scared uteri, uterine atony and uterine rupture. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk. The risk of peripartum hysterectomy seems to be significantly decreased by limiting the number of cesarean section deliveries, thus reducing the occurrence of abnormal placentation in the form of placenta accreta, increta or percreta.

Sonographic Measurement of Lower Uterine Segment Thickness to Predict Uterine Rupture During a Trial of Labor in Women With Previous Cesarean Section

Along with the increasing rate of cesarean section (CS) births has been a concomitant decrease in the rate of vaginal birth after cesarean (VBAC), mostly due to concerns about uterine rupture during a trial of labor (TOL). The risk of uterine rupture in laboring women with a previous CS must be balanced against the increasing current and future risk of peripartum hysterectomy with repeat cesarean. Improved prediction of uterine rupture could allow women at low risk to have a TOL, and those at high risk for uterine rupture could undergo a planned CS. Thinning in the lower uterine segment (LUS) measured by ultrasonography is a possible predictor of uterine rupture. The present study was performed to identify an optimal LUS thickness cutoff value and to define groups of women with a history of previous CS to whom TOL either should not be offered or could be offered safely. PubMed and EMBASE were searched for relevant articles published during 1980 to 2011. Included studies reported on pregnant women with at least 1 prior CS and on the sonographic appearance of the LUS during pregnancy in relation to uterine defects observed during or immediately after delivery. Studies were scored on methodologic and clinical characteristics. For each study, a 2 x 2 table was constructed, cross-classifying LUS thickness measured by ultrasound and the presence of LUS defect after delivery. Sensitivity and specificity were determined for each study in the receiver operating characteristic (ROC) space along with a corresponding summary ROC curve. From an initial 147 citations, 21 studies (all cohort design) were included and involved 2776 women. The median sample size was 71 (range, 10-642; interquartile range, 149.5). Lower uterine segment measurements were obtained at 34 to 39 weeks' gestation. Cutoff values used to define an insufficient LUS ranged from 0.5 to 3.0 mm in studies measuring myometrial LUS thickness and from 1.5 to 5.1 mm in those using full LUS thickness. Full LUS thickness measurement using cutoffs of 2.0 to 3.0 mm had a specificity of 0.91 (95% confidence interval [CI], 0.80-0.96) at a sensitivity of 0.61 (95% CI, 0.42-0.77). Full LUS thickness measurement using cutoffs of 3.1 to 5.1 mm had a specificity of 0.63 (95% CI, 0.30-0.87) at a sensitivity of 0.96 (95% CI, 0.89-0.98). The accuracy of transvaginal or transabdominal sonography could not be compared statistically because of the limited number of studies. The main finding is the strong negative correlation between LUS thickness and risk of uterine defect. The similar shapes of the ROC curves for myometrial and full LUS thickness indicated no significant difference in accuracy, shape, and position. An ideal screening test to predict uterine rupture could affect medical decision making by allowing accurate selection of women with a scarred uterus unlikely to have uterine rupture and thus able to have a TOL

Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage

Objectives The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD). Study design This prospective study from 2004 to 2007 was carried out in three Dublin maternity hospitals. Women were identified as having MOH if they received ≥5 units of red cell concentrate (RCC) acutely. Risk factors for hysterectomy or end organ dysfunction were calculated using logistic regression. Results One hundred and seventeen cases of MOH in 93,291 deliveries were identified (1.25/1000). The predominant cause was uterine atony. Haemostasis was achieved with medical therapy alone in 15% of cases. The hydrostatic balloon and the B-Lynch suture arrested bleeding in 75% and 40% of cases utilised respectively. Hysterectomy was required to arrest bleeding in 24% of women and 16% of women developed end organ dysfunction (11 had both). There was one maternal death. Independent risk factors for hysterectomy included the number of previous caesarean sections (OR 3.28, 95% CI 1.95–5.5), placenta praevia (OR 13.5, 95% CI 7.7–184), placenta accreta (OR 37.7, 95% CI 7.7–184), uterine rupture (OR 7.25, 95% CI 1.25–42) and the number of units of RCC transfused (OR 1.31, 95% CI 1.13–1.5). Independent risk factors for end organ dysfunction (EOD) were placenta accreta (OR 5, 95% CI 1.5–16.5), uterine rupture (OR 13.86, 95% CI 2.32–82), the number of RCC transfused (OR 1.31, 95% CI 1.13–1.5) and the minimum haematocrit recorded (OR 5.53, 95% CI 1.7–18). Conclusions MOH is complicated by hysterectomy in 24% and end organ dysfunction in 16% of cases. The risk of peripartum hysterectomy is increased with the number of previous caesarean sections, the aetiology of the bleed, namely placenta praevia/accreta or uterine rupture and the volume of blood transfused. Critically, failure to maintain optimal haematocrit during the acute event was associated with end organ dysfunction.

Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study

To provide an estimate of the incidence of peripartum hysterectomy in the state of New Jersey and calculate the effect of mode of delivery and prior obstetric history. A perinatal-linked dataset provided by the Maternal Child Health Epidemiology Program in the New Jersey Department of Health was used to obtain information from birth certificates and hospital discharge records. Using multivariate logistic regression, various demographic and clinical factors were assessed for association with peripartum hysterectomy. A total of 1,004,116 births were identified between 1997 and 2005 and 853 peripartum hysterectomies were performed (0.85/1,000 deliveries). Parity increased the risk of hysterectomy with nulliparous women having approximately half the risk compared to multiparous women. Cesarean delivery with no previous c-section almost doubled the risk (OR 2.20, CI 1.80-26.69) while in the presence of a previous c-section the risk was almost four times higher (OR 4.51, CI 3.76-5.40). Operative vaginal delivery did not result in any increase in the risk. Mode of delivery and prior obstetric history are major risk factors for peripartum hysterectomy. Patients desiring cesarean delivery need to be counseled on the risk of this serious complication.

The Possible Correlation between the Patient's Immune Tolerance Level During Cesaerean Section and the Incidence of Subsequent Emergency Peripartum Hysterectomy

Introduction. Cesarean section is an independent risk factor for peripartum hysterectomy. As a method of delivery, cesarean section may interfere with a number of molecular changes that occur at the maternal-fetal interface during the course of labor. Methods. The level of CD3, CD56, CD25, and CD69 antigen immunoreactivity was assessed by immunohistochemistry in 26 decidual tissue samples. The tissue samples were obtained from 18 women who underwent cesarean sections at term and from 8 women who underwent cesarean hysterectomies. Results. An increase in the activity and infiltration of immune cells in the decidua sampled during the spontaneous beginning of labor was observed. The further progression of labor was accompanied by a decrease in the number and activity of immune cells. The number of CD56+ and CD3+ cells in the decidua was statistically significantly lower in patients who had undergone cesarean hysterectomies than in those who had had cesarean sections at term. Conclusion. Abnormal immune response during labor may increase the risk for peripartum hysterectomy.

Emergency obstetric hysterectomy—an increasing incidence

Ten women underwent obstetric hysterectomy at St George's Hospital, London between 1992 and 1998, with an apparent seven-fold increase in incidence in recent years. All hysterectomies were performed as emergency procedures, with massive postpartum haemorrhage being the major indication for operation in nine cases. Abnormal placentation was the single commonest cause, seven cases being associated with previous caesarean section. There were no maternal or fetal mortalities, but major surgical complications, including urinary tract and vascular injury occurred in one case. In view of the increasing risk of obstetric hysterectomy following previous caesarean section, high risk cases associated with abnormal placentation may be identified using ultrasound, allowing appropriate pre-operative counselling regarding the risk of peripartum hysterectomy.