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Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a tertiary teaching hospital and to compare the results with literature data.

Methods

Retrospective study of 51 patients who underwent EPH at the Department of Gynecology, Obstetrics and Urology of the University of Rome Sapienza, from January 2000 to December 2013. Maternal characteristics of the index pregnancy and delivery, indications for EPH, operative and postoperative complications, maternal and neonatal outcome were acquired by the hospital records. Fisher’s and Chi-square tests were performed for statistical analysis.

Results

There were 51 EPH out of 23,384 deliveries, for an incidence of 2.2 per 1,000 deliveries during the study period. Forty-nine EPHs were performed after caesarean delivery (CS) and two after vaginal delivery (p < 0.0001). The most common indications were abnormal placentation (49.0 %), followed by uterine atony (41.2 %), and uterine rupture (9.8 %). Eighty percent of patients who underwent EPH with abnormal placentation had at least one previous CS (p < 0.01). Twenty-three patients (45.1 %) underwent total hysterectomy, the most frequent indication being abnormal placentation (76 %, p < 0.01). The remaining 28 patients underwent subtotal hysterectomy (54.9 %), the most frequent indication being uterine atony (85.7 %, p < 0.01). Maternal morbidity was 25.5 % and mortality was 5.9 %. Perinatal mortality was 3.9 %.

Conclusions

Abnormal placentation was the most common indication for EPH, requiring in most of the cases a total hysterectomy. Previous CS was a risk factor for abnormal placentation and in particular for pathological adherence of the placenta. EPH remains associated with a high incidence of morbidity and mortality.

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References

  1. Rossi AC, Lee RH, Chmait RH (2010) Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol 115(3):637–644. doi:10.1097/AOG.0b013e3181cfc007

    Article  PubMed  Google Scholar 

  2. Zelop CM, Harlow BL, Frigoletto FD Jr, Safon LE, Saltzman DH (1993) Emergency peripartum hysterectomy. Am J Obstet Gynecol 168(5):1443–1448

    Article  CAS  PubMed  Google Scholar 

  3. Stanco LM, Schrimmer DB, Paul RH, Mishell DR Jr (1993) Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol 168(3 Pt 1):879–883

    Article  CAS  PubMed  Google Scholar 

  4. Bakshi S, Meyer BA (2000) Indications for and outcomes of emergency peripartum hysterectomy. A five-year review. J Reprod Med 45(9):733–737

    CAS  PubMed  Google Scholar 

  5. Kastner ES, Figueroa R, Garry D, Maulik D (2002) Emergency peripartum hysterectomy: experience at a community teaching hospital. Obstet Gynecol 99(6):971–975

    Article  PubMed  Google Scholar 

  6. Forna F, Miles AM, Jamieson DJ (2004) Emergency peripartum hysterectomy: a comparison of cesarean and postpartum hysterectomy. Am J Obstet Gynecol 190(5):1440–1444. doi:10.1016/j.ajog.2004.02.021

    Article  PubMed  Google Scholar 

  7. Kayabasoglu F, Guzin K, Aydogdu S, Sezginsoy S, Turkgeldi L, Gunduz G (2008) Emergency peripartum hysterectomy in a tertiary Istanbul hospital. Arch Gynecol Obstet 278(3):251–256. doi:10.1007/s00404-007-0551-x

    Article  PubMed  Google Scholar 

  8. Imudia AN, Awonuga AO, Dbouk T, Kumar S, Cordoba MI, Diamond MP, Bahado-Singh RO (2009) Incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy: a 17-year experience from a single institution. Arch Gynecol Obstet 280(4):619–623. doi:10.1007/s00404-009-0984-5

    Article  PubMed  Google Scholar 

  9. Awan N, Bennett MJ, Walters WA (2011) Emergency peripartum hysterectomy: a 10-year review at the Royal Hospital for Women, Sydney. Aust N Z J Obstet Gynaecol 51(3):210–215. doi:10.1111/j.1479-828X.2010.01278.x

    Article  PubMed  Google Scholar 

  10. Demirci O, Tugrul AS, Yilmaz E, Tosun O, Demirci E, Eren YS (2011) Emergency peripartum hysterectomy in a tertiary obstetric center: nine years evaluation. J Obstet Gynaecol Res 37(8):1054–1060. doi:10.1111/j.1447-0756.2010.01484.x

    Article  PubMed  Google Scholar 

  11. Lone F, Sultan AH, Thakar R, Beggs A (2010) Risk factors and management patterns for emergency obstetric hysterectomy over 2 decades. Int J Gynaecol Obstet 109(1):12–15. doi:10.1016/j.ijgo.2009.10.012

    Article  PubMed  Google Scholar 

  12. Jones B, Zhang E, Alzouebi A, Robbins T, Paterson-Brown S, Prior T, Kumar S (2013) Maternal and perinatal outcomes following peripartum hysterectomy from a single tertiary centre. Aust N Z J Obstet Gynaecol 53(6):561–565. doi:10.1111/ajo.12135

    Article  PubMed  Google Scholar 

  13. Sahin S, Guzin K, Eroglu M, Kayabasoglu F, Yasartekin MS (2013) Emergency peripartum hysterectomy: our 12-year experience. Arch Gynecol Obstet. doi:10.1007/s00404-013-3079-2

    Google Scholar 

  14. Parazzini F, Ricci E, Cipriani S, Chiaffarino F, Bortolus R, Chiantera V, Bulfoni G (2013) Temporal trends and determinants of peripartum hysterectomy in Lombardy, Northern Italy, 1996-2010. Arch Gynecol Obstet 287(2):223–228. doi:10.1007/s00404-012-2547-4

    Article  PubMed  Google Scholar 

  15. Stivanello E, Knight M, Dallolio L, Frammartino B, Rizzo N, Fantini MP (2010) Peripartum hysterectomy and cesarean delivery: a population-based study. Acta Obstet Gynecol Scand 89(3):321–327. doi:10.3109/00016340903508627

    Article  PubMed  Google Scholar 

  16. Kwee A, Bots ML, Visser GH, Bruinse HW (2006) Emergency peripartum hysterectomy: a prospective study in The Netherlands. Eur J Obstet Gynecol Reprod Biol 124(2):187–192. doi:10.1016/j.ejogrb.2005.06.012

    Article  PubMed  Google Scholar 

  17. Baskett TF (2003) Emergency obstetric hysterectomy. J Obstet Gynaecol 23(4):353–355. doi:10.1080/0144361031000119466

    Article  CAS  PubMed  Google Scholar 

  18. Selo-Ojeme DO, Bhattacharjee P, Izuwa-Njoku NF, Kadir RA (2005) Emergency peripartum hysterectomy in a tertiary London hospital. Arch Gynecol Obstet 271(2):154–159. doi:10.1007/s00404-004-0715-x

    Article  PubMed  Google Scholar 

  19. Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192(5):1458–1461. doi:10.1016/j.ajog.2004.12.074

    Article  PubMed  Google Scholar 

  20. Turner MJ (2010) Peripartum hysterectomy: an evolving picture. Int J Gynaecol Obstet 109(1):9–11. doi:10.1016/j.ijgo.2009.12.010

    Article  PubMed  Google Scholar 

  21. Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177(1):210–214

    Article  CAS  PubMed  Google Scholar 

  22. Eniola OA, Bewley S, Waterstone M, Hooper R, Wolfe CD (2006) Obstetric hysterectomy in a population of South East England. J Obstet Gynaecol 26(2):104–109. doi:10.1080/01443610500443196

    Article  CAS  PubMed  Google Scholar 

  23. Hershkowitz R, Fraser D, Mazor M, Leiberman JR (1995) One or multiple previous cesarean sections are associated with similar increased frequency of placenta previa. Eur J Obstet Gynecol Reprod Biol 62(2):185–188

    Article  CAS  PubMed  Google Scholar 

  24. Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH (2005) Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 193(3 Pt 2):1045–1049. doi:10.1016/j.ajog.2005.06.037

    Article  PubMed  Google Scholar 

  25. Yucel O, Ozdemir I, Yucel N, Somunkiran A (2006) Emergency peripartum hysterectomy: a 9-year review. Arch Gynecol Obstet 274(2):84–87. doi:10.1007/s00404-006-0124-4

    Article  PubMed  Google Scholar 

  26. Knight M, Kurinczuk JJ, Spark P, Brocklehurst P (2008) Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 111(1):97–105. doi:10.1097/01.AOG.0000296658.83240.6d

    Article  PubMed  Google Scholar 

  27. Whiteman MK, Kuklina E, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, Marchbanks PA (2006) Incidence and determinants of peripartum hysterectomy. Obstet Gynecol 108(6):1486–1492. doi:10.1097/01.AOG.0000245445.36116.c6

    Article  PubMed  Google Scholar 

  28. Sheiner E, Levy A, Katz M, Mazor M (2003) Identifying risk factors for peripartum cesarean hysterectomy. A population-based study. J Reprod Med 48(8):622–626

    PubMed  Google Scholar 

  29. Jou HJ, Hung HW, Ling PY, Chen SM, Wu SC (2008) Peripartum hysterectomy in Taiwan. Int J Gynaecol Obstet 101(3):269–272. doi:10.1016/j.ijgo.2007.12.004

    Article  PubMed  Google Scholar 

  30. Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD (2009) Factors associated with peripartum hysterectomy. Obstet Gynecol 114(1):115–123. doi:10.1097/AOG.0b013e3181a81cdd

    Article  PubMed Central  PubMed  Google Scholar 

  31. Christopoulos P, Hassiakos D, Tsitoura A, Panoulis K, Papadias K, Vitoratos N (2011) Obstetric hysterectomy: a review of cases over 16 years. J Obstet Gynaecol 31(2):139–141. doi:10.3109/01443615.2010.536858

    Article  CAS  PubMed  Google Scholar 

  32. Shah M, Wright JD (2009) Surgical intervention in the management of postpartum hemorrhage. Semin Perinatol 33(2):109–115. doi:10.1053/j.semperi.2008.12.006

    Article  PubMed  Google Scholar 

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Conflict of interest

All authors declare that they have no conflicts of interest.

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The manuscript does not contain clinical studies or patient data.

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Authors and Affiliations

  1. Department of Gynecology, Obstetrics and Urology, Policlinico Umberto I, University “Sapienza”, Viale del Policlinico, 155, 00155, Rome, Italy

    Stella D’Arpe, Silvia Franceschetti, Roberto Corosu, Innocenza Palaia, Violante Di Donato, Giorgia Perniola, Ludovico Muzii & Pierluigi Benedetti Panici

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  1. Stella D’Arpe
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  2. Silvia Franceschetti
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  3. Roberto Corosu
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Correspondence to Stella D’Arpe.

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D’Arpe, S., Franceschetti, S., Corosu, R. et al. Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review. Arch Gynecol Obstet 291, 841–847 (2015). https://doi.org/10.1007/s00404-014-3487-y

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  • DOI: https://doi.org/10.1007/s00404-014-3487-y

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