Peripartum hysterectomy
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S. Castaneda
Abstract
Objectives: To review the cases receiving peripartum hysterectomies treated in this hospital during the period 1967–1995. Clinical characteristics, indications, and results were more closely analyzed.
Study design: A chart review of all cases operated since January 1967 to December 1995 was done. Demographic and clinical data were extracted, coded, and entered into a computer file for analysis. Indications, type of operation, pre-op planning or emergency decision, blood loss, transfusion, complications, were compared and cross-tabulated. Statistical analysis included: chisquare and Fisher exact tests, where appropriate, and two-sample t test.
Results: In 58% of 217 cases the operation was planned, and total hysterectomy was done in 94%. Indications changed through the years, from predominantly elective to almost exclusively emergencies. These were mostly bleeding complications, in particular placenta previa and/or accreta. The presence of a uterine scar or submucous fibroid was associated with 79% (26/33) of accretas, and 51% (19/37) of previas. Among the 126 planned, 57% did not receive a transfusion and 84% of 91 emergencies did have one. The average amount of blood received by the latter was 3009 ml compared to 1262 ml for the former (p < 0.0001). There was a direct relationship between amount of blood loss and volume transfused. There were 26% intraoperatory bleeding complications and 5% urinary tract injuries. Postoperatory morbidity such as bleeding, infections, wound dehiscence, and others was observed in 17% of planned, and 23% of emergencies. Twelve patients needed another operation to treat some of these complications. There were no deaths recorded.
Conclusions: Peripartum hysterectomy is a major operation, and in current times almost always an emergency with high risk for significant blood loss. The obstetrician should be ready to do it, and an early decision should save blood and prevent complications. Postoperative complications, mostly bleeding and infections may be severe. Early intervention and proper technique facilitate good outcomes.
Copyright (c)2000 by Walter de Gruyter GmbH & Co. KG
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- Peripartum hysterectomy
- Wishes and expectations of pregnant women and their partners concerning delivery
- Prevalence and risk factors for prelabor rupture of the membranes (PROM) at or near term in an urban Swedish population
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Articles in the same Issue
- Author Index
- Subject Index
- Contents
- Ellis van Creveld syndrome (chondroectodermal dysplasia, MIM 22550) in three siblings from a non-consanguineous mating
- Effect of maternal weight gain on infant birth weight
- Neonatal echocardiograms of macrosomic neonates
- Effects of surfactant treatment on gas-exchange and clinical course in near-term newborns with RDS
- Adolescent pregnancy: positive perinatal outcome at a community hospital
- Prostaglandin induced cortical hyperostosis in neonates with cyanotic heart disease
- Management of cervical cerclage at term: remove the suture in labor?
- Expedited human immunodeficiency virus testing of mothers and new-borns with unknown HIV status at time of labor and delivery
- The pathogenesis of pre-eclampsia: new aspects
- Peripartum hysterectomy
- Wishes and expectations of pregnant women and their partners concerning delivery
- Prevalence and risk factors for prelabor rupture of the membranes (PROM) at or near term in an urban Swedish population
- “Shake hands”; Diagnosing a floppy infant – Myotonic dystrophy and the congenital subtype: a difficult perinatal diagnosis
- Effect of corticosteroids on HELLP syndrome: a case report
