1. Emergency peripartal hysterectomy – a single-center analysis of the last 13 years at a tertiary perinatal care unit.
- Author
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de Gregorio, Amelie, Friedl, Thomas W.P., Scholz, Christoph, Janni, Wolfgang, Ebner, Florian, and de Gregorio, Nikolaus
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DISEASE risk factors , *INFECTION risk factors , *PREVENTIVE medicine , *UTERINE diseases , *PLACENTA diseases , *HEMORRHAGE risk factors , *MATERNAL mortality , *ACADEMIC medical centers , *CESAREAN section , *EMERGENCY medical services , *RED blood cell transfusion , *HYSTERECTOMY , *MATERNAL health services , *EVALUATION of medical care , *PREGNANCY , *PRENATAL diagnosis , *SURGEONS , *DISEASE incidence , *RETROSPECTIVE studies , *PLATELET count , *TERTIARY care ,PREGNANCY complication risk factors ,SURGICAL complication risk factors ,MORTALITY risk factors - Abstract
Background: Peripartal hysterectomy (PH) is a challenging surgical procedure with elevated maternal morbidity. Methods: From 2004 to 2016, 41 emergency PHs were performed at the tertiary care center of the Department of Gynecology and Obstetrics at University Hospital Ulm. In our retrospective analysis, the incidence of PH in our hospital was 12.8 per 10,000 deliveries with a maternal mortality of 2.4%. PH followed in 80.5% after cesarean section (c-section). Underlying causes/indications for PH were abnormal placentation (53.7%; n=22), uterine atony (26.8%; n=11), uterine lacerations (14.6%; n=6) and in rare cases uterine infection (4.9%; n=2). The median number of transfused products was 11 packed red blood cells (range 0–55 products), 10 fresh frozen plasma units (range 1–43) and two platelet concentrates (0–16). Results: Loss of blood as estimated by surgeons was significantly correlated with actual transfused blood volume (P<0.001). Clinically relevant intra- and/or postoperative complications occurred in 53.7% of patients (n=22). Abnormal placentation was the leading cause for PH with an increased incidence during the last 10 years presumptively representing the elevated rate of c-sections. Conclusion: PH goes along with increased rates of blood product transfusions independently of indication for surgery and has a high morbidity with a major complication rate of more than 50%. Prepartal assessment of risk factors like abnormal invasive placenta are crucial for reducing maternal morbidity. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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