Underwent Peripartum Hysterectomy Research Articles

Comparative study of the prevalence of organ injury in placenta accreta spectrum disorder between posterior colpotomy and conventional peripartum hysterectomies at a single referral center in southern Thailand.

To compare the prevalence of adjacent organ injury in placenta accreta spectrum disorder (PAS) between the posterior colpotomy approach and conventional peripartum hysterectomy. This retrospective study analyzed the data of pregnant women diagnosed with PAS who underwent peripartum hysterectomy at Songklanagarind Hospital between January 2006 and December 2021. The patients were divided into two groups: posterior colpotomy and conventional approaches. The characteristics and surgical and obstetric outcomes were compared. Univariate and multivariate logistic regression was used to identify factors and risk of organ injury. Among 174 patients, 64 underwent conventional peripartum hysterectomy, and 110 underwent the posterior colpotomy approach. The overall incidence of adjacent organ injury was 17.82%. Organ injury prevalence was lower in the posterior colpotomy group (10%) than in the conventional group (31.25%), with no difference in operative time. Multivariate analysis showed that posterior colpotomy reduced adjacent organ injury (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.06-0.54, P = 0.002). Placenta percreta was associated with increased injury risk (OR 6.83, 95% CI 2.53-18.44, P < 0.002). Subgroup analysis showed that the posterior approach reduced bladder injury in placenta increta (OR 0.14, 95% CI 0.04-0.57, P = 0.003) and percreta (OR 0.19, 95% CI 0.05-0.77, P = 0.017). Compared with conventional peripartum hysterectomy, the posterior colpotomy approach in patients with PAS reduced the risk of adjacent organ injury, particularly for placenta increta and percreta. This technique should be considered in PAS cases, but further investigations with a prospective study design are needed.

Women's Experiences Following Peripartum Hysterectomy: A Qualitative Study.

Peripartum hysterectomy is a major operation and is inevitably performed where certain indications require removal of the uterus at the time of delivery or in the immediate postpartum period. It is a traumatic birth event that affects women's physical, physiological, psychological, social, and sexual health. This study aimed to explore the lived experiences of women undergone peripartum hysterectomy. Qualitative phenomenological design was adopted to explore the lived experiences of women undergone peripartum hysterectomy. Purposive sampling technique was adopted to enroll the participants and 19 women were interviewed before saturation of responses was reached. All interviews were audio recorded and then transcribed into verbatims. Colaizzi's thematic analysis method was used to analyze the data. Based on participants' verbatims eight major themes emerged: Awareness status regarding peripartum hysterectomy; Body's response to peripartum hysterectomy; Perceived need of support; Facilitators in overcoming post-hysterectomy challenges; Relational turbulence; financial burden; Perceived psychological adaptation; Disturbed body image and low self-esteem. Derived themes in the present study highlighted the multidimensional effects of peripartum hysterectomy. Peripartum hysterectomy affected physical, psychological, sexual and financial health of the women. Increased dependence and changes in the self concept are the other problems faced by peripartum hysterectomy women. Need based individualized psychological therapeutic interventions will facilitate the successful adaptation to the traumatic situation by the reinforcement of positive coping mechanisms.

Evaluation of first-trimester complete blood count inflammatory indices in placenta previa

Aim: To evaluate systemic inflammation in pregnant women diagnosed with placenta previa (PP). First-trimester complete blood count indices of PP patients were assessed. Materials and Method: This cross-sectional study was conducted with 346 singleton pregnant women, including 115 PP cases (study group) and 231 healthy pregnant women (control group) who were operated on in a tertiary center for one year. The study group was then divided into two subgroups. Those who underwent peripartum hysterectomy due to placenta accreta spectrum (PAS) were determined as PAS-positive, and those without invasion were PAS-negative. Demographic and obstetric characteristics laboratory results were recorded retrospectively. Systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) values were calculated. Data were presented as mean and standard deviation using the independent sample t-test. Results: The mean value of maternal age, body mass index, and gestational weeks at which hemograms were evaluated were similar between the study and control groups. While white blood cell and neutrophil counts were significantly higher in the PP group, red blood cell and hemoglobin counts were lower (p

Surgical Strategies in Placenta Accreta Spectrum; A Quasi-experimental study

Objective: To evaluate maternal outcome in placenta accrete spectrum with bilateral internal iliac artery ligation before and after obstetric hysterectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Oct 2022 to Sep 2023. Methodology: Seventy patients enrolled in the study underwent peripartum hysterectomy. Bilateral Internal Iliac Ligation was performed before obstetrical hysterectomy in 40 patients of Group -1, whereas it was done after hysterectomy in 37 patients of Group-2. In all cases, the baby was delivered via classical caesarean section, with the placenta left in situ, followed by the closure of the uterine incision. The number of blood transfusions, Intensive care unit stay, post-operative haemoglobin level, post- operative recovery events, and duration of hospital stay, along with demographic details, were noted. Results: Out of 77 patients, the mean age of patients was 28.79±3.05. Most patients (n=36, 46.8%) had the previous three scars. Fifty-four cases (70.1%) had bladder injury involving mucosa. 22(28.6%) females had post- operative haemoglobin ≤7g/dl. Our study revealed statistically significant differences in the type of bladder injury (p=0.024) and post- operative severe anaemia, i.e. Hb≤7g/dl (p=0.006) among the two groups. Conclusion: Bilateral internal iliac artery ligation prior to obstetrical hysterectomy leads to a reduction in post-operative severe anaemia and mucosal involvement in bladder injury.

To Determine the Quality of Life in Indian Women After Peripartum Hysterectomy Using a Hindi Version of the SF-36 Questionnaire.

The objective of the study was to determine the quality of life in women after peripartum hysterectomy using a Hindi version of the SF-36 questionnaire. There are long-term effects on quality of life in women after peripartum hysterectomy. The effects on physical, mental, and social functioning have a prolonged recovery. No studies have been done in Indian women after peripartum hysterectomy to evaluate quality of life. Patients who underwent peripartum hysterectomy from January 2017 to May 2021 were contacted to participate in the study. To determine the quality of life post-surgery, a Hindi version of the 36-item Short-Form Health Survey (SF-36) was used for a face-to-face personal interview-based assessment. The participants were divided into two groups based on the duration between surgery and the interview. The aggregate scores for the eight components of SF-36 were calculated, and responses were analyzed. Out of the 138 post-hysterectomy women, 118 were enrolled in the study. Women who could not be contacted [14 (10.14%)] and those who died post-procedure [6 (4.35%)] were excluded. Out of the total, 43 assessed participants were within 2years of surgery, and 75 were after 2years of surgery. The group that was assessed after 2years of surgery had a significantly lower quality of life in six, out of the eight aspects of SF-36 domains. Women after peripartum hysterectomy undergo a prolonged recovery phase with effects on physical, mental, and social functioning. A multi-disciplinary long-term follow-up including physiotherapy and psychotherapy is required and that should be guided by a dedicated clinical team.

Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)-A Hospital-Based Study.

Placenta accreta spectrum (PAS) is a clinical entity significantly increasing the risk of a peripartum hemorrhage. Various surgical methods have been described in the literature, which aim to reduce the risk of bleeding, although they often lack reproducibility and have been performed on low numbers of patients. The aim of this study was to evaluate the use of the Foley catheter as a cervical tourniquet during cesarean sections, in patients with PAS. All patients who underwent peripartum hysterectomy due to PAS in a large single-center registry were included in the present analysis. The general demographics and clinical characteristics of all participants, including blood loss, and maternal and fetal outcomes, were collected and analyzed. Twelve participants were included. The mean blood loss was 1200 ± 760 ml during operation and the mean ± SD procedural duration was 89 ± 17 min. The median (Q1-Q3) length of hospital stay post-procedurally was 5 (4-6) days. None of the patients required subsequent urgent surgical procedures after hysterectomy. The median (Q1-Q3) packed red blood cell units transfused in our cohort was 2 (0-3). Using the Foley catheter as a tourniquet might be an effective method of excessive bleeding prevention in patients with PAS during peripartum hysterectomy.

INCIDENCE, INDICATION AND OUTCOME OF EMERGENCY PERIPARTUM HYSTERECTOMIES IN A TERTIARY CARE HOSPITAL

BACKGROUND: Emergency peripartum hysterectomy is the life-saving procedure to control a life-threatening haemorrhage performed at the moment or within 24 hrs of delivery (caesarean or vaginal). It is linked to a substantial percentage of maternal morbidity and mortality.AIM:To estimate the incidence,indication,and outcome of emergency peripartum hysterectomy over a 1-year period in a tertiary care hospital and the leading cause of the increased no of hysterectomies in the defined time interval. MATERIAL AND METHODS: This is a prospective study done in SMGS HOSPITAL, JAMMU, a tertiary care hospital. This study included all women who underwent emergency peripartum hysterectomy over a span of 1 year (August 1,2021,to July 31,2022).Detailed review including previous obstetric history, details of index pregnancy, an indication of peripartum hysterectomy, outcome, and infant morbidity was taken into account. RESULTS: During the course of the research, there were 33 women who had undergone peripartum hysterectomy. The incidence rate was 1.8 cases per 1000 births. The predominant indications were placenta accreta (69%),Atonic PPH (Postpartum haemorrhage) (18%),and uterine rupture (9%).Emergency peripartum hysterectomies were more prevalent after caesarean section (73%) than vaginal births (27%).Previous caesarean,multiparity,any past uterine surgeries, and older age were risk factors. 48% of women needed intensive care postoperatively.The common maternal complications were bladder injury (intraop) (12%), febrile morbidity (18%), disseminated intravascular coagulation (DIC) (8%),acute kidney injury (AKI) (9%),and wound infection (10%).There were 2 maternal deaths (6%) following emergency peripartum hysterectomy. The patient's condition was taken into consideration while deciding whether a complete or partial hysterectomy would be best.CONCLUSIONS: Abnormal placentation,placenta accreta, has surpassed uterine atony as the leading cause of emergency hysterectomy during the perinatal period in recent years. The primary reason for this is the growing popularity of caesarean sections. Peripartum hysterectomies for diagnosed cases of placenta accreta with antenatal anticipation of the risk factors,a multidisciplinary approach and ICU backup had better outcomes with less morbidity.An important factor influencing the maternal outcome was the timing of the decision to perform a peripartum hysterectomy which is neither too early nor too late

Differences in Surgery Classification and Indications for Peripartum Hysterectomy at a Major Academic Institution.

Peripartum hysterectomy is associated with increased morbidity and mortality relative to elective gynecologic hysterectomy and its incidence has grown with the rising cesarean delivery rate. We sought to understand indications and perioperative outcomes for peripartum hysterectomy at our academic institution and to evaluate differences among racial/ethnic groups. We performed a retrospective chart review of women at a tertiary care center who underwent delivery of a newborn and had a peripartum hysterectomy during the same admission between 2008 and 2018. Demographic, clinical, and socioeconomic characteristics of patients were compared with respect to patient's race/ethnic group. A total of 112 hysterectomies were included in our study. White women undergoing peripartum hysterectomy were more likely to have had an elective/anticipated peripartum hysterectomy (vs. a nonelective/emergent peripartum hysterectomy) than Black women. There were racial differences detected in the indication for peripartum hysterectomy; White women were more likely to have abnormal placentation (75 vs. 54% in Black women, p = 0.036), whereas Black women were more likely to present with postpartum hemorrhage (27 vs. 2%, p = 0.002). Black women were also more likely to undergo reoperation after peripartum hysterectomy (15 vs. 2% in White women, p = 0.048). There were no differences in any other perioperative outcomes including blood transfusion, accidental laceration, and 30-day readmission. Differences exist among elective versus nonelective peripartum hysterectomy by race/ethnicity and in indications for peripartum hysterectomy by race/ethnicity. Further investigation should be performed to determine whether the differences identified are due to disparate management of atony/postpartum hemorrhage or inequitable referral patterns for suspected abnormal placentation by race/ethnicity. · White patients were more likely to have an elective hysterectomy when compared with Black women.. · Abnormal placentation was the indication more often for White patients; hemorrhage for Black ones.. · Black patients were likely to be nulliparous or at greater gestational age at the time of hysterectomy..

PERIPARTUM HYSTERECTOMY -INCIDENCE, INDICATIONS, RISK FACTORS AND OUTCOMES AT A TERITIARY CARE HOSPITAL

Introduction: Peripartum hysterectomy is defined as a hysterectomy performed at the time, or within 24 hours, of delivery. It is a life saving procedure and becomes necessary when all medical and surgical methods fail to control bleeding. It is associated with significant maternal morbidity and mortality. Objectives: To determine the incidence, indications, maternal and perinatal outcome of peripartum hysterectomy Methods: A retrospective hospital based observational study of all women who underwent peripartum hysterectomy over a period of 2 years from January 2020 to December 2021 in the department of Obstetrics and Gynaecology, SIDDARTHA MEDICAL COLLEGE, VIJAYAWADA. Results: A total of 20 peripartum hysterectomies were done during the study period. Incidence was 1.08/1000 deliveries. Main indications of peripartum hysterectomy were uterine atony (45%), abnormal placentation (30%), and uterine rupture (10%). Total abdominal hysterectomy was done in 15% cases and subtotal hysterectomies were done in 85% cases. There was one maternal death (5%) and 5 perinatal deaths (25%). Conclusion: Atonic uterus is the commonest indication for peripartum hysterectomy. Previous scar, multiparity and abnormal placentation were the significant risk factors.

Emergency peripartum hysterectomy - our 6 years of experience.

Peripartum hysterectomy is a life-saving procedure performed during and after vaginal delivery or cesarean section. The incidence of placental invasion anomaly is increasing in parallel with the increase in the number of births by cesarean section. It was aimed to evaluate the frequency, risk factors and outcomes of peripartum hysterectomy performed in a tertiary hospital. Research data were obtained by a retrospective review of patient files. Patients who underwent peripartum hysterectomy because of postpartum hemorrhage in the Gynecology and Obstetrics Clinic of Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Turkey, were included in the present study. The patients were divided into two groups as those who underwent emergency peripartum hysterectomy (EPH) and those who did not. Demographic variables, fetal and maternal mortality, EPH indications, additional surgeries performed during EPH, and intra- or postoperative complications were collected. Pearson chi-square test was used for statistical analysis. There were 22,464 deliveries, of which 13,514 were delivered vaginally and 8,950 by cesarean section. Peripartum hysterectomy was performed on 42 patients (vaginal 16, cesarean section 26). The most common EPH indications in both groups were placenta accreta spectrum (42.9/ 3.2%), followed by uterine atony (38.1/ 2.5%). The most common risk factor for EPH was found to be a history of previous cesarean sections. Placental invasion anomalies that cause severe postpartum hemorrhage are due to increased cesarean rates. Currently, the most common indication of EPH is placental invasion anomalies.

The role of fetal fibronectin and plasminogen activator inhibitor 1 biomarkers in antenatal prediction of placenta accreta spectrum

In this study, we aimed to assess the determining role of foetal fibronectin (FFN) and plasminogen activator inhibitor type (PAI-1) levels in the antenatal prediction of placenta accreta spectrum in cases with risk factors for placenta accreta spectrum. Singleton live pregnancies with placenta previa or low-lying placenta within 32–34 weeks of gestation were included in the study. The cases were divided into two groups after delivery as those with PAS and those with normal placentation. 54 cases diagnosed with placenta previa or low-lying placenta were included in the study. 17 of the cases underwent peripartum hysterectomy due to placenta accreta spectrum. 37 cases with normal placentation underwent caesarean delivery. Foetal fibronectin (p:.03) and PAI-1 (p:.02) levels were determined to be significantly different between cases with placenta accreta spectrum and cases with normal placentation. AUC for foetal FFN was calculated to be 0.69, while the AUC for, PAI-1was 0.66. Results for both FFN and PAI-1 were not found useful enough for the diagnosis of PAS. IMPACT STATEMENT What is already known on this subject? We lack biomarkers which can identify placenta accreta spectrum. What do the results of this study add? Maternal plasma levels of FFN and PAI-1 significantly altered in PAS What are the implications of these findings for clinical practice and/or future research? If multiple of median values of FFN and PAI-1 levels in maternal blood are determined in future studies, it can be used in the antenatal diagnosis of PAS cases.

A case series on abnormal placenta accreta spectrum in a rural tertiary care centre

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The main complication of PAS is due to it’s massive obstetric haemorrhage which leads to maternal morbidity and mortality. The incidence of placenta accreta spectrum increases day by day due to an alarming increase in caesarean section rates. Depending on the range of invasiveness, The Placenta accreta spectrum is classified as placenta accreta, placenta increta and placenta percreta. The etiology of placenta accreta spectrum is that a defect of the endometrial–myometrial interface leading to failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration. In recent times, prenatal ultrasound scanning with gray scale imaging and color Doppler imaging seems to be an excellent tool for screening of PAS.We report here a series of 5 cases of Placenta Accreta who reported to hospital as Bleeding P/v or USG scan report showing Abnormal Placental invasion or Placental Position. Patients reported were posted for Emergency LSCS under definitive indications but underwent Peripartum hysterectomy. The Ultrasound findings were subsequently confirmed at surgery and proven on histopathological examination. Peripartum hysterectomy remains the life saving procedure over conservative methods for PPH secondary to Abnormal Placental invasion.

The clinical evaluation of IIA balloon occlusion in caesarean delivery for patients with PAS: a retrospective study

ObjectiveThe aim of this study is the clinical evaluation of IIA balloon occlusion in the caesarean delivery in patients with a diagnosis of placenta accreta spectrum.BackgroundHigh incidence of cesarean section leads to the increasing incidence of placenta accreta spectrum (PAS), which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality.MethodsFifty-eight patients with a diagnosis of PAS were retrospectively reviewed. The balloon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL). The secondary outcomes were cesarean hysterectomy, blood transferring volume, operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes.ResultsNo difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis, surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10 [43.48%] vs. 11 [31.43%], P=0.350). Complications related to occlusion of IIA did not occur. The duration of the surgery of the balloon group was significantly longer than that of the control group (123.52 min±74.76 versus 89.17±48.68, P=0.038), and the total hospitalization cost was also significantly higher than that of the control group (45116.67±9358.67 yuan versus 30615.41±11587.44 yuan, P=0.000).ConclusionIt does not permit to draw final conclusions for us on the effectiveness of the balloons IIA given the heterogeneity of selection of cases undergoing the procedures in the retrospective design. However, it is possible that IIA balloon occlusion may contribute to limiting intraoperative blood loss in more severe cases, particularly those undergoing peripartum hysterectomy.

Emerging Trends in Peripartum Hysterectomy; A High Alert in Obstetrics

Introduction: The high incidence of lower segment caesarean section (LSCS) leading to morbidly adherent placenta and making it a leading cause of peripartum hysterectomy.Objective: Peripartum hysterectomy is one of the major obstetrical procedures that need to be performed electively/emergency in patients having morbidly adherent placenta (MAP) for the sake of the patient’s life. Need to conduct this study arises because we want to highlight the increasing rate of peripartum hysterectomy secondary to MAP, the emerging trend of increased LSCS in our socio-demographic strata, and its effects on maternal morbidity and mortality.Materials and Methods: This was a retrospective study which was carried out in the Department of Obstetrics and Gynaecology Unit II, Holy Family Hospital, Rawalpindi. All patients who underwent peripartum hysterectomy were included in the study. Data was collected from record files and labor room registers in accordance with ethical guidelines.Results: Out of 11,440 deliveries in one year, 60 patients underwent peripartum hysterectomy with an incidence of 5.2 per 1000 deliveries. The majority of patients (87%) fell in the age group of 25-33 years. 4(6.6%) patients undergone peripartum hysterectomy for postpartum hemorrhage (PPH) due to uterine atony, 3(5%) due to the ruptured uterus, and 53(88%) due to MAP. All patients who had undergone a peripartum hysterectomy due to MAP were previously scarred for LSCS (100%). 5% with previous 1 LSCS, 31% with previous 2 LSCS, 44% with previous 3 LSCS and 18% with previous 4 LSCS.Conclusion: The high incidence of peripartum hysterectomies in young patients secondary to MAP highlights the need for critical review and audit of indications of primary LSCS and repeat LSCS. It also highlights the need for expertise at the time of surgery to decrease the rate of maternal morbidity and mortality.

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

BackgroundWe aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting.MethodsAll women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study.ResultsA total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period.ConclusionOur findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.

Incidence, Management and Outcomes in Women Undergoing Peripartum Hysterectomy in a Tertiary Care Centre in India.

BackgroundPeripartum hysterectomy (PRH) is the surgical removal of the uterus performed in obstetrical complications such as uncontrolled postpartum haemorrhage (PPH), unrepairable uterine rupture, and sepsis. Its incidence has increased in recent years. The objective of this study was to review all the cases of PRH in a tertiary care teaching hospital over three years (January 2017-December 2019) to determine its incidence and analyse clinico-demographic characteristics in these women.MethodAll women undergoing PRH from January 2017 to December 2019 were included in the study. Data were collected retrospectively from medical records, of patients who underwent a PRH at the time of delivery, or within 24 hours, or performed any time before discharge from the same hospitalization and obstetric event. The total number of deliveries including caesarean and vaginal deliveries were recorded. Main outcome measures were the incidence of PRH, indication for hysterectomy, management option used, maternal outcomes (PPH, bladder injury and maternal death) and fetal outcomes (stillbirth).ResultsThere were a total of 3904,4 deliveries; 27,337 vaginal and 11,697 caesarean sections in three years. A total of 50 patients underwent a PRH. The incidence of PRH in our study was 1.3 per 1,000 deliveries and 3.5/1,000 caesareans, respectively. PRH was found to be more common following cesarean sections than vaginal deliveries (odds ratio 22.86 [95% CI: 8.16 to 63.98]). Morbid adherent placenta (MAP) (n=30, 62%) was the most common indications of PRH. Seven (15%) women had PRH due to uterine rupture. Twenty-seven women of the 30 women (90%) with the MAP had a previous caesarean delivery. The case fatality rate per hysterectomy was 4%. Stillbirth rate (SBR: n=8,16%) among women having PRH was seven-fold higher than overall SBR in our country.ConclusionThere has been a rise in MAP as an indication of PRH in our study for a decade in comparison to uterine atony. Caesarean delivery is a significant risk factor for PRH. Previous caesarean section and major placenta previa were common occurring obstetric risk factors present in the MAP in our cohort. Our maternal mortality in PRH was low and the stillbirth rate was high when compared with national data.

Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries.

IntroductionPeripartum hysterectomy is applied as a surgical intervention of last resort for major obstetric hemorrhage. It is performed in an emergency setting except for women with a strong suspicion of placenta accreta spectrum (PAS), where it may be anticipated before cesarean section. The aim of this study was to compare management strategies in the case of obstetric hemorrhage leading to hysterectomy, between nine European countries participating in the International Network of Obstetric Survey Systems (INOSS), and to describe pooled maternal and neonatal outcomes following peripartum hysterectomy.Material and methodsWe merged data from nine nationwide or multi‐regional obstetric surveillance studies performed in Belgium, Denmark, Finland, France, Italy, the Netherlands, Slovakia, Sweden and the UK collected between 2004 and 2016. Hysterectomies performed from 22 gestational weeks up to 48 h postpartum due to obstetric hemorrhage were included. Stratifying women with and without PAS, procedures performed in the management of obstetric hemorrhage prior to hysterectomy between countries were counted and compared. Prevalence of maternal mortality, complications after hysterectomy and neonatal adverse events (stillbirth or neonatal mortality) were calculated.ResultsA total of 1302 women with peripartum hysterectomy were included. In women without PAS who had major obstetric hemorrhage leading to hysterectomy, uterotonics administration was lowest in Slovakia (48/73, 66%) and highest in Denmark (25/27, 93%), intrauterine balloon use was lowest in Slovakia (1/72, 1%) and highest in Denmark (11/27, 41%), and interventional radiology varied between 0/27 in Denmark and Slovakia to 11/59 (79%) in Belgium. In women with PAS, uterotonics administration was lowest in Finland (5/16, 31%) and highest in the UK (84/103, 82%), intrauterine balloon use varied between 0/14 in Belgium and Slovakia to 29/103 (28%) in the UK. Interventional radiology was lowest in Denmark (0/16) and highest in Finland (9/15, 60%). Maternal mortality occurred in 14/1226 (1%), the most common complications were hematologic (95/1202, 8%) and respiratory (81/1101, 7%). Adverse neonatal events were observed in 79/1259 (6%) births.ConclusionsManagement of obstetric hemorrhage in women who eventually underwent peripartum hysterectomy varied greatly between these nine European countries. This potentially life‐saving procedure is associated with substantial adverse maternal and neonatal outcome.

814 Association between peripartum hysterectomy and venous thromboembolism

The risk of venous thromboembolism (VTE) postpartum is modified by mode of delivery, with the risk of VTE being higher after cesarean compared to vaginal delivery. The risk of VTE following peripartum hysterectomy is largely unknown. The objective of this study was to compare the incidence and risk of VTE among women who had and did not have a peripartum hysterectomy. This is an observational study using data from the Nationwide Readmission Database from 10/2015 to 12/2017. Delivery encounters and all variables of interest were identified using ICD-10 diagnosis and procedure codes. The incidence of VTE during the delivery encounter to within 6 weeks of discharge was compared among women who had and did not have a peripartum hysterectomy. Multivariable logistic regressions were used to estimate associations between VTE and hysterectomy, adjusted for patient characteristics known to be associated with VTE risk. Analyses used survey weights to obtain population estimates. P-values <0.05 were considered significant. Of the 4,419,037 women with deliveries, 5,098 (115 per 100,000 deliveries) underwent hysterectomy. 110 were diagnosed with VTE after hysterectomy, of which 87 (79%) occurred during the delivery admission. The incidence of VTE was significantly higher in women who did vs. did not undergo peripartum hysterectomy: 2,153.4 vs. 87.7 per 100,000 deliveries (p<0.001). The adjusted odds of VTE in women after hysterectomy was significantly higher compared to women who had a vaginal or cesarean delivery and no hysterectomy (Table 1). Characteristics between patients who underwent peripartum hysterectomy with and without VTE did not differ significantly, suggesting there may be limited need for further VTE risk stratification after a hysterectomy (Table 2). Pregnancy-related hysterectomy is associated with significantly increased risk of VTE in the postpartum period. These findings prompt further investigation into the role for routine VTE prophylaxis in the postpartum period extending beyond the delivery hospitalization as a risk-reducing strategy after hysterectomy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Reloadable Stapler Use during Peripartum Hysterectomy for Placenta Accreta Spectrum: A Novel Surgical Technique and Case Series.

This study aimed to describe a novel surgical technique for the management of antenatally suspected placenta accreta spectrum (PAS). This is a retrospective, case series of patients with suspected PAS undergoing peripartum hysterectomy with a reloadable articulating stapler at a tertiary care center. Eighteen patients with antenatally suspected PAS were identified and underwent peripartum hysterectomy with the aid of a reloadable stapler. Mean gestational age at delivery was 344/7 ± 11/7 weeks. Mean total operative time (skin-to-skin) was 117.3 ± 39.3 minutes, and 79.8 ± 19.8 minutes for the hysterectomy. Mean blood loss for the entire case was 1,809 ± 868 mL. Mean blood loss for the hysterectomy was 431 ± 421 mL. Mean units of intraoperative red blood cells transfused was 3 ± 1 units. Mean units of postoperative red blood cells transfused was 1 ± 0.5 units. Five cases were complicated by urological injury (two intentional cystotomies). Four patients were admitted to the intensive care unit (ICU) for a mean of ≤24 hours. Mean postoperative LOS was 4.11 ± 1.45 days. Three patients had final pathology that did not demonstrate PAS while four were consistent with accreta, six increta, and five percreta. Use of a reloadable articulating stapler device as part of the surgical management of antenatally suspected PAS results in a shorter operative time (117 ± 39 minutes vs. 140-254 minutes previously reported), lower average blood loss (1,809 ± 868 mL vs. 2,500-5,000 mL previously reported) and shorter LOS (4.11 ± 1.45 days vs. 9.8 ± 13.5 days previously reported) compared with traditional cesarean hysterectomy. The reloadable stapling device offers an advantage of more rapidly achieving hemostasis in the surgical management of PAS. · PAS is associated with severe maternal morbidity.. · Decreased operative time and blood loss have many clinical benefits.. · Reloadable stapler use for PAS decreases operative time.. · Reloadable stapler use for PAS decreases operative blood loss..

The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications.

To compare perioperative outcomes by patient race/ethnicity. A retrospective cohort study identified 7 331 638 childbirth hospitalizations for women aged 12-55years in the USA between 2004-2014. Peripartum hysterectomy, in-hospital mortality, perioperative complications, length of stay, and cost of hysterectomy data were analyzed using SAS. Among childbirth hospitalizations (52.9% white, 13.5% black, 23.0% Hispanic, 5.2% Asian, and 5.4% other), peripartum hysterectomy occurred in 6619. The incidence of peripartum hysterectomy was 90.3 (95% confidence interval [CI] 87.7-93.0) per 100 000 hospitalizations, and higher for black (111.0, 95% CI 104.5-117.4), Hispanic (104.9, 95% CI 99.1-110.8), and Asian women (119.6, 95% CI 109.1-130.2) compared to whites (75.7, 95% CI 72.8-78.5). After adjustment, Hispanic women had an 18% higher odds of undergoing peripartum hysterectomy (odds ratio [OR] 1.18, 95% CI 1.08-1.29; P=0.004) than white women. Non-white women had a 2-3-fold higher odds of in-hospital mortality (ORblack 2.76, 95% CI 1.44-5.30; ORHispanic 1.99, 95% CI 1.04-3.82; ORAsian+other 2.44, 95% CI 1.11-5.40. Black and Asian/other women were more likely to undergo blood transfusions. Women of color have higher rates of peripartum hysterectomy and experience higher rates of poor perioperative outcomes and mortality.