Arch Gynecol Obstet DOI 10.1007/s00404-013-3079-2

MATERNAL-FETAL MEDICINE

Emergency peripartum hysterectomy: our 12-year experience Sadik Sahin • Kadir Guzin • Mustafa Erog˘lu • Furkan Kayabasoglu • Mustafa Serdar Yas¸ artekin

Received: 29 July 2013 / Accepted: 29 October 2013 Ó Springer-Verlag Berlin Heidelberg 2013

Abstract Objective The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH). Methods We analyzed retrospectively 44 cases of EPH performed at tertiary obstetric center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH, and postoperative follow-up were obtained by analyses of hospital records. Results The overall incidence of EPH was 0.48 per 1,000 deliveries during the study period. The most common indications of EPH were abnormal placentation (50 %), uterine atony (36 %) and uterine rupture (9 %). All patients who underwent EPH with abnormal placentation had one or more previous cesarean sections (CS) except one. In our series, 24 cases (54 %) underwent total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %), whereas subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %). Maternal mortality was seen in 2 patients (4.5 %). The causes were disseminated intravascular coagulation in

S. Sahin (&)  M. Erog˘lu Depatment of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, ¨ stu¨nel Cad. No:10, U ¨ sku¨dar, Opr. Dr. Burhanettin U Istanbul 34668, Turkey e-mail: [email protected] K. Guzin  F. Kayabasoglu  M. S. Yas¸ artekin Clinics of Gynecology and Obstetrics, Goztepe Education and Research Hospital, Medeniyet University of Istanbul, Istanbul, Turkey

one and adult respiratory distress syndrome in the other patient. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4 and prematurity in 3 patients. Conclusions In our series, abnormal placentation was the most common indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH. Keywords Peripartum hysterectomy  Abnormal placentation  Uterine atony  Maternal morbidity and mortality

Introduction A growing body of evidence suggests that postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality throughout the world. When the other treatment strategies fail, emergency peripartum hysterectomy (EPH) has been regarded as the gold standard and a life-saving procedure in severe postpartum obstetric hemorrhage [1]. Nowadays invasive placental diseases of pregnancy, uterine atony and rupture have been shown to be pioneering etiologies for EPH [2]. In current obstetric practice, the profile of patients has changed dramatically and the majority of them have the history of previous cesarean sections, advanced maternal age. These risk factors increase the incidence of invasive placental diseases and uterine atony that are accepted to be the main causes for performing EPH [3]. In this study, we aimed to review our 12-year experience in patients undergoing EPH in a tertiary obstetric center.

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Materials and methods We retrospectively analyzed the data of 44 patients with EPH performed in our center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH and postoperative follow-up were obtained by analyses of hospital records. The study was approved by the Ethics Committee of the Medeniyet University, Istanbul. Emergency hysterectomy was performed as described previously by our group [4]. Briefly, when the life-threatening hemorrhage at the time of delivery or in the immediate 24 h after delivery is detected and if it is unresponsive to conventional treatments like fundal massage, administration of oxytocin and prostaglandins, curettage of the placental bed, use of blood products, and selective ligation of the ascending uterine artery and hypogastric artery, EPH is performed as a last resort to control massive peripartum blood loss. Mean maternal age, gravidity and parity, gestational ages, types of delivery, the incidence, risk factors for EPH were recorded. Peripartum maternal morbidity and mortality were evaluated. The surgical procedures, type of anesthesia and hysterectomy, operating time, the operative complications, amount of blood and blood product transfusions, febrile morbidity and the length of hospital stay were evaluated. Febrile morbidity was defined as described [4]. Disseminated intravascular coagulation (DIC) was classified as non-overt and overt DIC. Clinically, overt DIC was defined as both severe and oozing type of bleeding from surgical incisions or venous puncture sites, prolongation in activated partial thromboplastin time/prothrombin time or thrombocytopenia [International Society of Thrombosis and Hemostasis (ISTH) score above 5] [5]. Non-overt DIC was defined as having an ISTH score under 5 points [5]. All patients had general anesthesia for hysterectomy. Total and subtotal hysterectomies were performed as described [6]. The data related to our patient collective were compared with a control group. The control group had patients who underwent CS (n = 55) and vaginal delivery (n = 41) during the same period of the study (January 2001 to April 2013) and had been delivered on the same day as EPH patients. Both groups were followed up till hospital discharge. Statistical analysis was performed by SPSS 16.0 (Inc., Chicago, IL, USA). Data were expressed as continuous and categorical variables. Continuous variables were defined as mean and standard deviation (SD) and categorical variables were defined as percentages (%). Continuous variables were compared with student t test, while Chi-square test or Fisher’s exact test was used for comparison of categorical variables. Pearson correlation test was used to assess the

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correlation between clinical parameters and EPH. A p value of 0.05 was regarded as statistically significant.

Results During the 12-year period, a total of 91.927 births occurred in our center. Of these, the rates of vaginal delivery and CS were 62.667 (68 %) and 29.260 (32 %), respectively. The overall incidence of EPH was found as 0.48 among 1,000 deliveries. Demographic data of the control and the patients are given in Table 1. The mean age was significantly higher in the EPH group with respect to the controls. On comparison, the mean gravidity and the parity were significantly higher in the EPH group than in the controls. All of the patients were multigravid except for the 4 patients (9 %). The mean gestational ages were similar between the groups. Ten of the 44 patients in the EPH group had been followed up at the different outpatient clinics. Data related to antepartum follow-up were gathered successfully in all patients. Postoperative follow-up was completed in all patients and controls. In the EPH group, 34 (of 44) patients were delivered by cesarean section (77 %). The indications for cesarean section are given in Table 2. In the EPH group, 65 % (22 of the 34) of the patients underwent cesarean section due to abnormal placentation, while it was found to be 5.4 % in the control group. Furthermore, the second most common indication for cesarean section in the EPH group was placental abruption (18 %, 6 of the 34 patients); in the control group, the rate of placental abruption was only 3.6 % (2 of the 55). On the contrary, fetal distress and cephalopelvic disproportion were the significant common indications in the control group. There was no difference in terms of breech presentation between the groups. Of the 34 cesarean hysterectomies, 22 patients had a history of previous cesarean delivery, Table 1 Demographics and peripartum variables related to the control and EPH groups Control group (n = 96)

EPH group (n = 44)

p*

Age (years)

24.5 ± 2.7

32.7 ± 4.3

0.000

Gravidity

2.0 ± 0.9

3.8 ± 1.0

0.000

Parity

1.3 ± 0.7

2.4 ± 0.9

0.000

Gestational age (weeks)

36.9 ± 1.3

Birth weight (g)

3,165 ± 331

37.3 ± 1.5

0.23

3,242 ± 299

0.25

Transfusion unit Erythrocyte

0.1 ± 0.4

8.5 ± 3.1

0.000

Fresh frozen plasma

0.06 ± 0.2

4.3 ± 1.6

0.000

Platelets Hospitalization (days)

0

0.8 ± 1.2

0.000

2.6 ± 0.9

9.4 ± 2.0

0.000

* p \ 0.05 reflects significant difference

Arch Gynecol Obstet Table 2 Indications for cesarean section Control group (n = 96) (%)

Table 4 Comparison of total and subtotal hysterectomies EPH group (n = 34) (%)

p*

Total hysterectomy (n = 24)

Subtotal hysterectomy (n = 20)

p*

Abnormal placentation

3 (5.4)

22 (65)

0.000

Placental abruption

2 (3.6)

6 (18)

0.02

Abnormal placentation

18 (75 %)

4 (20 %)

0.0003

Fetal distress Previous cesarean section alone

17 (30) 14 (25)

1 (2.2) 1 (2.2)

0.000 0.000

Atony Rupture

4 (17 %) 1 (4 %)

12 (60 %) 3 (15 %)

0.003 0.21

Hematoma

1 (4 %)

1 (5 %)

0.49

Cephalopelvic disproportion

17 (30)

4 (12)

0.03

33.3 ± 3.8

31.8 ± 0.9

0.22

Primigravid breech position

2 (3.6)

0

0.49

* p \ 0.05 reflects significant difference

Table 3 Indications for EPH Indications for EPH

EPH group (n = 44)

Abnormal placentationa

22 (50 %)

With previous cesarean section

21

Without previous cesarean section

1

Uterine atony

16 (36 %)

After cesarean sectionb

10

After vaginal delivery

6

Ruptured uterus, lacerated cervix

4 (9 %)

Hematoma

2 (4 %)

a

Placenta previa and placenta accreta

b

Six patients with placental abruption in this group

9 of them with only one and 13 of them with two or more previous cesarean deliveries. All patients except one in EPH group with placenta previa had a previous CS history. Of the 10 hysterectomy cases after vaginal delivery, only one of them had the history of previous CS. The indications for EPH are shown in Table 3. Of which, the most common indication was abnormal placentation (50 %). The others were uterine atony (36 %) and uterine rupture (9 %). In our study group, we performed total hysterectomy in 24 (54 %) cases and subtotal hysterectomy in 20 (46 %) cases. Abnormal placentation was the most common indication for total hysterectomy (75 %), whereas subtotal hysterectomy was the choice of management in cases of uterine atony (60 %). Mean operating time for total hysterectomy was significantly longer than subtotal hysterectomy. On the contrary, we could not find any significant change in terms of demographic variables, and the days of hospitalization and complication rates between hysterectomy types (Table 4). Overall morbidity rate was 68 % (30 of 44). The most common of which was febrile morbidity (n = 12, 27 %). The other morbidities, in an order of frequency, were depression (n = 8, 18 %), non-overt DIC (n = 6, 14 %), overt DIC (n = 2, 4.5 %), hematoma (n = 2, 4.5 %),

Indication

Age Gravidity

3.7 ± 0.8

3.9 ± 1.2

0.54

Parity

2.3 ± 0.1

2.5 ± 0.2

0.60

Gestational age (weeks)

37.1 ± 0.2

37.5 ± 0.4

0.52

Birth weight (g)

3,194 ± 69

3,263 ± 121

Operating time (min)

154 ± 5

119 ± 3

0.61 \0.0001

Transfusion unit Erythrocyte

9.1 ± 0.6

7.7 ± 0.9

0.18

Fresh frozen plasma

5.0 ± 0.6

3.9 ± 0.6

0.26

Platelets

1.0 ± 0.2

0.5 ± 0.1

0.18

9.5 ± 0.6

9.2 ± 0.6

0.73

7 (29 %) 14 (58 %)

5 (25 %) 11 (55 %)

0.25 0.23

Hospitalization (days) Complications Febrile morbidity Other

* p \ 0.05 reflects significant difference

wound dehiscence (n = 2, 4.5 %), bladder injury (n = 2, 4.5 %), re-exploration for bleeding (n = 2, 4.5 %) and oophorectomy due to surgical ovarian trauma (n = 1, 2.2 %). In the control group, we observed only few postpartum morbidities such as wound dehiscence in 3 % (3 out of 96) and febrile illness in 2 % (2 out of 96). In the EPH group, the transfused units of erythrocyte suspension, fresh frozen plasma and thrombocyte suspension were significantly higher when compared to those in the controls (p = 0.000 for all). In addition, the mean length of hospital stay was markedly higher in the EPH group with respect to the controls (p = 0.000) (Table 1). In the EPH group, maternal mortality was seen in 2 patients (4.5 %). The causes were DIC in one and adult respiratory distress syndrome (ARDS) in the other patient. There was no maternal mortality in the controls. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4, prematurity in 3 patients. In the control group, perinatal mortality was seen in one newborn because of the prematurity.

Discussion Emergency peripartum hysterectomy, although it is a rare surgical procedure, is usually performed to control life-

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threatening hemorrhage whenever other treatment strategies fail. In this study, we review our experience in EPH and the incidence was found as 0.48 among 1,000 deliveries during a 12-year period in our study. The incidence of EPH in the vaginal and cesarean delivery groups was 0.16 and 1.2 in 1,000 deliveries, respectively, in the present study. In our previous study, the incidence was found as 0.37 per 1,000 deliveries [4]. The rates of the incidence of EPH have been reported as 0.24 in Denmark, 0.33 in the Netherlands, 0.46 in Canada, 0.85 in the USA, and 4 in Nigeria [7–11]. Our finding was consistent with the literature among the studies reported in Europe and Canada. It is well known that the incidence of EPH differs geographically. This finding results from lack of antenatal care, home delivery, delayed referral time to the hospital and socioeconomic status of the country [12]. Our study revealed that multiparity and advanced maternal age are the risk factors for EPH. This was consistent with a previous study showing that postpartum hemorrhage increased from 0.3 % in women with low parity to approximately 2 % in those with a parity number 4 or greater [13]. Owolabi et al. [10] reported that advanced maternal age and multiparity are independent risk factors for EPH. Chen et al. [14] also found that low birth weight and multiparity increase the relative risk of EPH (relative risks of 2.6 and 2.4, respectively). Other reported risk factors for EPH are multiple gestation, and magnesium sulfate and oxytocin infusion [15, 16]. In a meta-analysis, Rossi et al. [17] reviewed 981 patients with EPH and revealed that women at highest risk of emergency hysterectomy are those who are multiparous, had a CS in either a previous or the present pregnancy, or had abnormal placentation. In our previous study, age, gravida, parity, gestational age and low birth weight were the associated risk factors for EPH. In the present study, age, gravida and multiparity were found to be more prominent in patients with EPH. Fifty percent of our patients (22 of 44) undergoing EPH had at least one previous CS. This is correlated with the results in the literature, with a range from 18.8 to 60.5 % [18, 19]. A body of evidence suggests that history of previous CSs increases the risk for EPH compared to the vaginal deliveries. This clearly reflects the association between previous CS and abnormal placentation in subsequent pregnancies [20–23]. In the literature, it has been revealed that a history of CS causes a 10- to 12-fold increase in the risk of EPH [4, 24]. Moreover, Knight et al. showed that the number of previous CSs increases the risk of EPH dramatically. In the same study, women who have had one previous CS have more than double the risk of EPH in the next pregnancy and women who have had two previous CSs have [18 times the risk [25]. Our study revealed that the rate of CS was 29 % in the first 6 years of

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the study period, whereas it was 42 % in the later 6 years. The overall incidence of EPH also had risen from 0.37 to 0.48 per 1,000 deliveries. In our opinion, this finding could result from the increased rate of previous CS and also admission of the more placenta previa cases to our referral center during the last 6 years of the study. In a study by Flood et al., the overall CS delivery rate was found to increase from 6 to 19 % during the last two decades and the percentage of EPH that occurs in the setting of a previous cesarean delivery has increased from 27 to 57 % [3]. Our study demonstrated abnormal placental adhesion to be the most common indication (50 %) for EPH. All of the cases had a history of at least 1 CS except one. Our finding was correlated with previous reported studies [26, 27]. It is given that the rate of placenta accreta for EPH accounts for 38–51 % [3]. Kwee et al. prospectively analyzed their patients undergoing EPH and found that placenta accreta accounted for 50 % of their cases [8]. The number of previous CSs was related to an increased risk of placenta accreta, from 0.19 % for one previous CS to 9.1 % for four previous CSs in the same study. Miller et al. [23] reported a 10-fold increase in placenta accreta over the past 50 years, with a relative frequency of 1 per 2,500 deliveries. In our patient population, the second most common indication for EPH was uterine atony (36 %). Sixty-two percent of the cases with uterine atony were secondary to the CS operation and the atony was associated with placental abruption in the six of those patients with CS. This reflects that placental abruption is a risk factor for the uterine atony at the time of CS. Bodelon et al. [28] demonstrated that abruptio placenta increases the risk of EPH secondary to hemorrhage by 3.2 times. Gungorduk et al. [29] also reported that CS for placental abruption was an independent risk factor for EPH [odds ratio (OR) was 3.8]. In a nation-wide study by Bateman et al. [1], the risk of peripartum hysterectomy for atony associated with repeat CS increased nearly by 4-fold (OR 3.94) and that associated with primary cesarean delivery increased by 2.5-fold (OR 2.55). A lesser increase (OR 1.45) was observed for atony associated with vaginal deliveries. Adjustment for changes in the rates of traditional risk factors for atony (multiple births, fetal macrosomia, preterm labor, multiple births and fibroids and the like) did not fully explain the increased rate of peripartum hysterectomy. In our study, the rate of atony was decreased from 39 to 36 % in the last 6 years of the study period. In our opinion, this relative decrease would be linked to the increase in the number of patients with abnormal placentation. Flood et al. [3] claimed that this decrease in the rate of uterine atony might be attributed to a more successful conservative treatment of uterine atony with uterotonic agents and recent improvements in operative interventions decreasing the need for hysterectomy in their study. In contrast, EPH for uterine

Arch Gynecol Obstet

atony increased from 11.2 to 25.9 per 100,000 deliveries in a nation-wide study [1]. Uterine rupture was the third common indication for EPH (9 %) in our study. There was a decreasing tendency in the incidence of uterine rupture as an indication for EPH (11 vs. 9 %) that was correlated with the previous studies [1, 3]. It has been suggested that decreased parity of women, the more judicious use of oxytocin and the avoidance of trials of labor in the setting of previous classic CS are responsible for this decrease. Whiteman et al. [30] found that vaginal birth after CS was associated with an increased risk (OR 2.70) but of a smaller magnitude, compared with those women who underwent primary CS (OR 6.54) or those women who underwent repeat CSs (OR 8.90). These are factors to be considered strongly when the decision is being made about the benefits of trial of labor when there is a history of CS. In our series, 24 cases (54 %) had undergone total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %). However, subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %) whenever other treatment strategies failed in this study. The reported rates of subtotal hysterectomy by Zelop et al. [20], Parazzini et al. [31] and Kastner et al. [32] were 21, 33 and 80 %, respectively. Kastner et al. [32] claimed that patients who underwent total hysterectomy had a tendency for intensive care unit admission and postoperative complications. On the contrary, we did not reveal any differences in morbidity and mortality between total and subtotal hysterectomy groups. However, instead of total hysterectomy, the subtotal technique was found to be more advantageous in terms of operating times in these critically ill patients undergoing an emergent procedure. But, total hysterectomy might be inevitable in cases with abnormal placentation causing massive bleeding. It has been well known that total hysterectomy is a major threat to quality of life postoperatively in terms of sexual activity. Therefore, subtotal hysterectomy should be a preferred method of choice in patients undergoing EPH. Emergent peripartum hysterectomy is associated with high rates of maternal mortality and mortality. Our maternal mortality rate was 4.5 % that was comparable to the results in other studies (from 0 to 11.6 %) [33, 34]. The causes for maternal mortality in the present study were DIC and ARDS and both of which might be linked to massive perioperative transfusion of blood and blood products and the primary disease causing EPH. Hemorrhage, sepsis and hypertensive disorders (preeclampsia/eclampsia) are the leading causes of direct obstetric death (death related to the obstetric complications of pregnancy) in developing/low and middle income countries, whereas thromboembolic events are the most common cause of maternal mortality in developed countries [35–37]. In a recent meta-analysis

[17], overall maternal morbidity rate was high, involving approximately half of the women undergoing EPH that was comparable to our study (68 %). Of maternal morbidities, febrile morbidity (27 %), depression (18 %), non-overt DIC (14 %) and bladder injury (4.5 %) were the leading complications after EPH in our study. In the literature, the need of massive blood transfusions, coagulopathy, injury of the urinary tract, need for re-exploration because of persistent bleeding and febrile morbidity are the most common complications reported after EPH [16, 21]. Fever was the most frequent complication seen in EPH in a study by Rossi et al. [17]. In the literature, the rates of febrile morbidity ranging from 21 to 40 % have been reported [21, 38]. This seems to be related to the massive transfusions after EPH and emergent nature of the surgical procedure itself. Postpartum depression was another frequent complication seen in 18 %. Forna et al. [24] reported the rate of depression as low as 6 % after EPH. The majority of our patients were from the rural areas of the country and they were relatively in lower socioeconomic status. This might be the reason for a higher rate of depression in our study when compared to the literature. The incidence of other less frequent complications such as coagulopathy, hematoma, wound dehiscence, re-exploration for bleeding and oophorectomy due to surgical ovarian trauma was in accordance with the literature. Our study has some obvious limitations. First, data in the present were gathered in a retrospective fashion. This might decrease the statistical power of the study. Second, the number of patients included into the study was relatively small. In conclusion, our results show that EPH was associated with high morbidity and mortality in current obstetrical practice. Abnormal placentation related to previous CS deliveries accounts for the majority of cases undergoing EPH. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH. Conflict of interest of interest.

All authors declare that they have no conflicts

References 1. Bateman BT, Mhyre JM, Callaghan WM, Kuklina EV (2012) Peripartum hysterectomy in the United States: nationwide 14 year experience. Am J Obstet Gynecol 206(1):63.e1–63.e8 2. Wright JD, Bonanno C, Shah M, Gaddipati S, Devine P (2010) Peripartum hysterectomy. Obstet Gynecol 116(2):429–434 3. Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone FD (2009) Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol 200((6):632.e1–632.e6 4. 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

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Arch Gynecol Obstet 5. Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M (2001) Towards definition, clinical and laboratory criteria and a scoring system for disseminated intravascular coagulation. J Thromb Haemost 86(5):1327–1330 6. Hawkins J, Hudson CN (1977) Abdominal hysterectomy for benign conditions. In: Hawkins J, Hudson CN (eds) Shaw’s textbook of operative gynaecology, 4th edn. Churchill Livingstone, Scotland, pp 146–175 7. Sakse A, Weber T, Nickelsen C, Secher NJ (2007) Peripartum hysterectomy in Denmark 1995–2004. Acta Obstet Gynecol Scand 86(12):1472–1475 8. Kwee A, Bots ML, Visser GHA, Bruinse HW (2006) Emergency peripartum hysterectomy: a prospective study in the Netherlands. Eur J Obstet Gynecol 124(12):187–192 9. Wen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, Joseph KS, Kramer MS (2005) Severe maternal morbidity in Canada 1991–2001. CMAJ 173(7):759–764 10. Owolabi MS, Blake RE, Mayor MT, Adegbulugbe HA (2013) Incidence and determinants of peripartum hysterectomy in the metropolitan area of the District of Columbia. J Reprod Med 58(3–4):167–172 11. Omole-Ohonsi A, Olayinka HT (2012) Emergency peripartum hysterectomy in a developing country. J Obstet Gynaecol Can 34(10):954–960 12. Mahrukh F, Pashtoon MK, Shahnaz NB, Abaseen K (2011) Afghan experience of emergency peripartum hysterectomies at a tertiary care hospital in Quetta, Pakistan. ISRN Obstet Gynecol, article Id 854202 13. Babinszki A, Kerenyi T, Torok O, Grazi V, Lapinski RH, Berkowitz RL (1999) Perinatal outcome in grand and great-grand multiparity: effects of parity on obstetric risk factors. Am J Obstet Gynecol 181(3):669–674 14. Chen M, Zhang L, Wei Q, Fu X, Gao Q, Liu X (2013) Peripartum hysterectomy between 2009 and 2010 in Sichuan, China. Int J Gynaecol Obstet 120(2):183–186 15. Bakshi S, Meyer BA (2000) Indications for and outcomes of emergency peripartum hysterectomy. A five-year review. J Reprod Med 45(9):733–737 16. Yucel O, Ozdemir I, Yucel N, Somunkiran A (2006) Emergency peripartum hysterectomy: a 9-year review. Arch Gynecol Obstet 274(2):84–87 17. Rossi AC, Lee RH, Chmait RH (2010) Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol 115(3):637–644 18. Jou HJ, Hung HW, Ling PY, Chen SM, Wu SC (2008) Peripartum hysterectomy in Taiwan. Int J Gynecol Obstet 101(3):269–272 19. Rahman J, Al-Ali M, Qutub HO, Al-Suleiman SS, Al-Jama FE, Rahman MS (2008) Emergency obstetric hysterectomy in a university hospital: a 25-year review. J Obstet Gynaecol 28(1):69–72 20. Zelop CM, Harlow BL, Frigoletto FD Jr, Safon LE, Saltzman DH (1993) Emergency peripartum hysterectomy. Am J Obstet Gynecol 168(5):1443–1448 21. 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 22. Hershkowitz R, Fraser D, Mazor M, Leiberman JR (1995) One or multiple previous cesarean sections are associated with similar

123

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

increased frequency of placenta previa. Eur J Obstet Gynecol Reprod Biol 62(2):185–188 Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177(1):210–214 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 Knight M, Kurinczuk JJ, Spark P, Brocklehurst P (2008) Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 111(1):97–105 Orbach A, Levy A, Wiznitzer A, Mazor M, Holcberg G, Sheiner E (2011) Peripartum cesarean hysterectomy: critical analysis of risk factors and trends over the years. J Matern Fetal Neonatal Med 24(3):480–484 Sumigama S, Itakura A, Ota T et al (2007) Placenta previa increta/percreta in Japan: a retrospective study of ultrasound findings, management and clinical course. J Obstet Gynaecol Res 33(5):606–611 Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SDMD (2009) Factors Associated With Peripartum Hysterectomy. Obstet Gynecol 114(1):115–123 Gu¨ngo¨rdu¨k K, Yildirim G, Dugan N, Polat I, Sudolmus S, Ark C (2009) Peripartum hysterectomy in Turkey: a case–control study. J Obstet Gynaecol 29(8):722–728 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 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 Kastner ES, Figueroa R, Garry D, Maulik D (2002) Emergency peripartum hysterectomy: experience at a community teaching hospital. Obstet Gynecol 99(6):971–975 Glaze S, Ekwalanga P, Roberts G, Lange I, Birch C, Rosengarten A, Jarrell J, Ross S (2008) Peripartum hysterectomy 1999 to 2006. Obstet Gynecol 111(3):732–738 Rahman J, Al-Ali M, Qutub HO, Al-Suleiman SS, Al-Jama FE, Rahman MS (2008) Emergency obstetric hysterectomy in a university hospital: a 25-year review. J Obstet Gynaecol 28(3):69–72 You F, Huo K, Wang R, Xu D et al (2012) Maternal mortality in Henan Province, China: changes between 1996 and 2009. PLoS ONE 7(10):e47153 James AH, Jamison MG, Brancazio LR, Myers ER (2006) Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 194(5):1311 Wright JD, Devine P, Shah M et al (2010) Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol 115(6):1187–1193 El-Jallad MF, Zayed F, Al-Rimawi HS (2004) Emergency peripartum hysterectomy in Northern Jordan: indications and obstetric outcome (an 8-year review). Arch Gynecol Obstet 270(4):271–273

Emergency peripartum hysterectomy: our 12-year experience.

The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH)...
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