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Objective: To compare the prevalence of adjacent organ injury in placenta accreta spectrum disorder (PAS) between the posterior colpotomy approach and conventional peripartum hysterectomy. Methods: 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. Results: 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). Conclusion: 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. Synopsis: The posterior colpotomy approach in hysterectomy for placenta accreta spectrum disorders reduces adjacent organ injury compared with conventional peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

• PAS are associated with maternal and neonatal morbidity and consequent risk of developing PTSD. • The risk of PTSD must be valued motivating an early approach by multidisciplinary teams. • Psychiatric and/or psychological support are essential to prevent the onset of symptoms. Placenta Accreta Spectrum disorders (PAS) are a group of obstetric complications with an increasing incidence. The high maternal and neonatal morbidity and mortality associated with PAS leads to concerns about the negative psychological impact, and even the risk of developing Post-Traumatic Stress Disorder (PTSD). The aim of this study was to assess the psychological impact of PAS diagnosis and intervention during pregnancy and postpartum and its potential association with PTSD. STUDY DESIGN: A cross-sectional study was conducted, including cases of PAS FIGO grade 2 and 3 treated at University Hospital Center São João, between 2010–2023. Only cases with histopathological confirmation after peripartum hysterectomy were included. Data were obtained from electronic medical records (Sclinic® and Obscare®). The impact of Event Scale – Revised (IES-R), a validated questionnaire, was applied, after surgery for PAS, to assess the psychological impact of PAS diagnosis and treatment. Fourteen cases of PAS were identified. The mean maternal age was 36.8 years. Approximately 86 % of cases had antenatal suspicion. The mean gestational age at delivery was 34 weeks. Of the 14 women, only 11 responded to the request to participate in the study (7 interviewed in person and 4 remotely). Four women had IES-R scores indicative of high risk of PTSD (IES-R>33 points), one had an intermediate risk (IES-R between 24–32 points), and 6 fell into the low-risk category. The mean score was 22.4 points. The analysis of IES-R results by clusters showed higher scores in the intrusion category, which relates to intrusive and unwanted thoughts, images and memories. Given the high morbidity and mortality described in women with PAS, the risk of PTSD should be acknowledged, motivating early intervention to prevent the development of severe and potentially chronic symptoms. Supportive measures and psychiatric and/or psychological follow-up should be promptly implemented, ideally by multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Peripartum hysterectomy (PH), the surgical removal of the uterus during or shortly after childbirth, is a critical procedure in maternal health care. Definitions of PH vary globally, leading to challenges in understanding its occurrence. Our study aimed to provide comprehensive insights into PH in a South African context, investigating indications, demographic characteristics, clinical and histopathological diagnoses, complications, and outcomes.A retrospective record review study design was used, focusing on PH cases at a tertiary facility in Johannesburg, South Africa (SA), between January 2018 and December 2020. Medical records were systematically examined to identify trends, indications, and outcomes associated with PH. Data collection encompassed demographic characteristics, obstetric history, clinical indications, clinical and histopathological diagnoses, and complications. Data analysis used descriptive statistics, interrater reliability tests, and comparative findings with previous SA studies.The study included 56 pregnant women with a median age of 32 years (interquartile range: 25–35) who underwent PH between January 2018 and December 2020 at Charlotte Maxeke Johannesburg Academic Hospital in South Africa. We found that pregnancy‐related sepsis (PRS) emerged as the most common indication of PH, as reported among 18 (32.1%) of the women, with an 88.8% histopathological confirmation rate. Abnormal placentation (14/56, 25%) and PPH (8/56, 14%) were other common indications. Clinical and histopathological diagnoses exhibited a strong level of agreement (70.9%), emphasizing the importance of accurate diagnostics.Our study found a shift in the primary historical indications, such as uterine atony and uterine rupture in South Africa, with PRS emerging as the primary indication in recent years(2009‐2020). Clinical assessment complemented by histopathological findings remains critical for improved obstetric complication management. [ABSTRACT FROM AUTHOR]

Objective: To analyze the incidence, indications, risk factors and pregnancy outcomes of postpartum hemorrhage resulting in peripartum hysterectomy (PH). Methods: We retrospectively reviewed patients with postpartum hemorrhage requiring surgical procedures at ≥ 28 weeks of gestation from January 1, 2013 to December 31, 2022 at a tertiary hospital in Shanghai, China. The patients were divided into a PH group and a non-PH group. Maternal clinical characteristics, the management of postpartum hemorrhage, pregnancy outcomes were compared between groups. Logistic regression was used to analyze the correlations between risk factors and PH. Results: The incidence of hysterectomy was 0.2/1000 deliveries (31/150194). The variables significantly associated with PH were placenta previa with placenta increta/percreta (OR36.26), uterine rupture (OR266.16) and an estimated blood loss ≥ 3513 mL (OR431.11). The proportion of cases involving hemorrhagic shock, disseminated intravascular coagulation, bladder injury, neonatal severe asphyxia, neonatal death and hypoxic-ischemic encephalopathy were significantly higher in the PH group (P < 0.05). Conclusion: The most common indications of PH were placental pathology. Efforts should be made to reduce the rate of cesarean deliveries and uterine curettage to lower the probability of abnormal placental invasion and appropriate medical indications for trial of labor after cesarean should be strictly followed to avoid the risk of uterine rupture. [ABSTRACT FROM AUTHOR]

Objective: 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. Materials and methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China. Methods: This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed. Results: Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies. Conclusion: Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high‐risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH. Synopsis: Abnormal placentation is the primary indication for peripartum hysterectomy. Prenatal prevention, intrapartum monitoring, and timely control of postpartum hemorrhage are important in peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage remains a major cause of maternal mortality and morbidity worldwide with higher rates found in resource-challenged countries. Conventional use of uterotonics such as oxytocin, prostaglandins, and medications to support coagulation, such as fibrinogen and tranexamic acid, are helpful but may not be sufficient to arrest life-threatening postpartum hemorrhage. Severe postpartum hemorrhage leads to an increased need for blood transfusions and the use of invasive techniques, such as intrauterine balloon tamponade, compression sutures, and arterial ligation, as advanced steps in the management cascade. In extreme cases where hemorrhage is resistant to these therapies, a hysterectomy may be necessary to avoid possible maternal death. Uterine packing with a chitosan-covered tamponade is an emerging tool in the armamentarium of the obstetrical team, especially when resources for advance surgical and other invasive options may be limited. Modified chitosan-impregnated gauze was originally described in the management of acute hemorrhage in the field of military medicine, combining the physiological antihemorrhaging effect of modified chitosan with a compression tamponade for the acute treatment of wound bleeding. The first described use in obstetrics was in 2012, showing that the chitosan-covered tamponade is an effective intervention to arrest ongoing therapy-resistant postpartum hemorrhage. Further studies showed a reduction in hysterectomies and blood transfusions. The method is, however, underreported and is not yet an established method used worldwide. To demonstrate the step-by-step application of the intrauterine chitosan-covered tamponade in the management of therapy-resistant postpartum hemorrhage, we have produced a teaching video to illustrate the important steps and techniques to optimize the effectiveness and safety of this novel intervention. [ABSTRACT FROM AUTHOR]

Objective: 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. Materials and methods: 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. Results: 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. Conclusion: 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.

Objective: 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. Background: 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. Methods: 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. Results: 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 2 years of surgery, and 75 were after 2 years of surgery. The group that was assessed after 2 years of surgery had a significantly lower quality of life in six, out of the eight aspects of SF-36 domains. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. Methods: This was a descriptive, population‐based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. Results: Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. Conclusion: The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage. Synopsis: Incidence of peripartum hysterectomy was 0.91 per 1000 births. It was higher with advanced age, multiparity, and cesarean deliveries and leading reasons were placental pathologies. [ABSTRACT FROM AUTHOR]

Objective: To study maternal outcome in placenta accreta spectrum disorder in ANC patients of Vanivilas hospital. Materials and Methods: After obtaining approval and clearance from the institutional ethics committee, the in-patient and out-patients fulfilling the inclusion criteria will be enrolled for the study after obtaining informed consent. Details collected as per the case record and follow up form. A study was conducted among 40 suspected cases of placenta accreta spectrum disorder, data regarding general information, demographic data, obstetric history, gestational age, risk factors, management, blood loss, blood products transfusion, organ injury, outcome, HPE report, outcome(mortality & morbidity) are collected. The collected data is then compiled and analyzed. Results: 40 cases of PAS were managed over 1 year period, where PAS accounted for 0.276% out of 14000 deliveries conducted at Vanivilas hospital. 47.5% were belonging to the age group between 26-30yr, PAS has led to 5% of maternal death, 82.5% had morbidity which includes 30% had blood loss between 1.6-2liters, 27.5% had massive hemorrhage(>2lt), maximum blood loss was 3.5lt. 5% had sepsis, 5% with postpartum bleeding, 2.5% had acute renal failure, 20% had bladder injury, 2.5% had ureteric injury, 22.5% had prolonged hospital stay(>7 days), 15% had SSI. Conclusion: PAS accounted for 0.276% out of total deliveries in a year at Vanivilas hospital (14K) PAS disorders are an important cause of maternal morbidity (82.5%) and mortality(5%). Commonest risk factor being previous scarred uterus with placenta previa (85%) Sensitivity rate of USG in picking up adherent placenta is 31.5%, 80% were managed by peripartum hysterectomy, 10% required postpartum hysterectomy. 28.12% had bladder/ureteric injury, 85% required ICU stay, 22.2% required prolonged hospital stay, 87.5% required blood & blood products transfusion. 83.3% were HPE confirmed adherent placenta. [ABSTRACT FROM AUTHOR]

Aim: To investigate the outcomes of peripartum hysterectomies (PHs) conducted to prevent maternal morbidity and mortality at a tertiary care hospital with 15,000 deliveries per year. Method: Patients who underwent PHs during delivery and/or within 24 h of delivery between the years 2011–2022 were retrospectively evaluated. Hysterectomies not performed in the peripartum period, cases that were managed by methods such as balloon tamponade, compression suture, or arterial ligation rather than hysterectomy, and hysterectomies performed before 20 weeks were excluded. Obstetric and demographic characteristics of the cases, as well as indications and outcomes of PH, were investigated. Results: Among the 130 patients who underwent PH, 4 (3.04%) patients delivered vaginally, 1 (0.7%) patient delivered vaginally after cesarean section, 12 (9.2%) patients delivered by primary cesarean section, and 113 (86.9%) patients delivered by secondary cesarean section. Placenta accreta spectrum disorder was the reason for PH in 54.6% (n = 71) of the cases while 16.1% (n = 21) underwent PH due to uterine atony. The PH rate was 0.75 per 1000 births, and the maternal mortality rate was 7.6 per 1000 hysterectomies in this study. Conclusion: Obstetricians in developed/ing countries support the active management of the third stage of labor mainly to mitigate the preventable risk factors of post-/peri-partum hemorrhage. The current study suggests that obstetricians need to focus on the placenta in order to reduce PH. [ABSTRACT FROM AUTHOR]

Background : Obstetric hysterectomy is indicated when patient’s life is at risk, and it is a procedure that requires a highly experienced and skilled medical team to solve any complication. Aims & Objectives To determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency peripartum hysterectomy in this institution .Material & Methods. a Retrospective, observational, and analytical study over a period of one year4 months, from november 2021 to February2023. A total of25 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, BMGMC Shahdol M.P. Results: The overall incidence of EOH was 25 out of 5584 deliveries. Uterine rupture (36%) was the most common indication followed by Atonic postpartum hemorrhage(16%).The most frequent sequelae were febrile morbidity (56%) and Acute Kidney Injury(13.5%). Maternal mortality was 12% whereas perinatal mortality was 68%.Conclusion: Skill in emergency obstetric hysterectomy remains a necessary tool for consultant obstetricians. In spite of intra operative risks and post-operative complications, it remains a potentially life saving procedure. The maternal outcome greatly depends on timely decision and good clinical judgment because unnecessary delay can cost life and undue haste can cause morbidity. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to find out the incidence of obstetric hysterectomy and to study and analyze indications, risk factors, complications, morbidity, and mortality in both mother and fetus associated with obstetric hysterectomy. Methods: It is an observational prospective study conducted at Government Medical College & Hospital, Aurangabad, Maharashtra, India with cases of obstetric hysterectomy done from the conception of pregnancy till the end of puerperium over 2 years. Result: During the study period, there were 43768 confinements out of which 55 cases underwent obstetric hysterectomy giving an incidence of 0.13%. Incidence following vaginal delivery was 0.05% and following cesarean section was 0.30%. The most common indication was morbidly adherent placenta (50.90%), followed by uterine atony (36.36%) and rupture uterus (14.55%). 63.64% had previous cesarean deliveries as a risk factor. Maternal mortality was 9.09% cases. 63.60% of babies went home alive. Conclusion: Caesarean section and its sequel like morbidly adherent placentae have changed the trend and topped now as an indication of obstetrics hysterectomy.

Background-Peripartum hysterectomy is the surgical removal of the uterus performed in obstetrical complications such as uncontrolled postpartum haemorrhage (PPH), unrepairable uterine rupture, and sepsis during or immediately after abdominal and vaginal deliveries. Its incidence has increased in recent years. The objective of this study was to review all the cases of Peripartum hysterectomy in a Kamla Raja Hospital, Gajra Raja Medical College, Gwalior.(July 2020-July 2022) to determine its incidence, management and outcomes in women who underwent peripartum hysterectomy. Materials and Method-All women undergoing peripartum hysterectomy from July 2020 to July 2022 were included in the study. Details of the women who underwent peripartum hysterectomy wascollected from the case files, OT registers and SNCU registers. The total number of deliveries i.e caesarean and vaginal deliveries were included. Results-A total of 54 cases were collected over a period of 2 years. The incidence of peripartum hysterectomies in our study was 0.19/1,000 vaginal deliveries and 5.1/1,000 caesarean (CS) deliveries. The mean age of women undergoing hysterectomy was 29.46 years, with 28 women (51.8%) less than 30 years. Thirty six women (66.68%) were anaemic with mean preoperative haemoglobin of 8.02 g/dl. Sixty-six percent of women underwent emergency hysterectomy. In our study a total 28/54 women that accounts for 51.85% of the caseshad placenta previa of which 22 were abnormally invasive morbidly adherent placenta. Abnormally invasive morbidly adherent placenta accounts for 68.51% and massive postpartum haemorrhage accounts for 37.03% of the cases and were major indications for peripartum hysterectomy. In our study 18.25 % of patients had isolated atonic PPH, while 51.85% of the cases had placenta previa in combination with atony or abnormally invasive placenta or uterine rupture. Uterine rupture accounts for 4/54 cases i.e 7.40%. More than 50 % of the hadhaemorrhage due to two or more factors (uterine atony, morbid adherent placenta, and traumatic uterine rupture). Uterine atony constituted as the cause of PPH 18.25% women single handedly, 55.56% of the cases presented in the emergency hours with minimal prior workup. Average duration of ICU stay in our study was 5.1 days and 11.11% of the cases required ventilator support .83.33% of the patients underwent total hysterectomy which inferred from the fact that majority of the cases presented with placenta previa and abnormally invasive placenta. Uterine artery ligation was done in 48.14% of the cases. Internal iliac artery ligation was done in 7.40% of the cases. The febrile illness was the most common post peripartum hysterectomy complication and the Bladder injury was the second most common intraoperative complication. One women died, one due to coagulopathy. The maternal mortality ratio for PRH was 2.78 per 100,000 live births. Stillbirth rate was 29.62%. Conclusion-Over time, caesarean section rates have skyrocketed, leading to life-threatening complications like scar rupture, placenta accreta spectrum, bladder injuries, adnexal bleeding, and broad ligament hematomas. This requires the health care system to identify high-risk women prior to workup to rule out placental invasion, improve hemoglobin stores, control hypertension, and provide appropriate management. Resident doctors need emergency obstetric hysterectomy training and workshops. Patients, family members, and outreach workers like ASHAs and ANMs should be advised that a planned caesarean section is better than attempting a home birth and arriving late to the hospital in obstructed labor. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to determine the l evel of attitudes of medical students towards scientific researches. In the study, it was also examined whether there was a significant difference between students' attitudes towards researches according to their gender and grade levels. Materials and Methods: In this study, 110 placenta percreta patients who were delivered between January 2021 and January 2022 in the gynecology and obstetrics clinic of Harran University were included in the study. The patients were grouped according to the number of previous cesarean sections; Pregnant women's age, weeks of delivery, prepartum and postpartum blood transfusion needs, 1st and 5th minute APGAR scores of their babies, intraoperative and postoperative complications, length of hospital stay, and peripartum invasion status according to the status of performing preventive surgery/hysterectomy were retrospectively analyzed from the file records. Results: As the number of previous cesarean section increased, the hysterectomy status of the groups formed based on the number of cesarean sections was found to be statistically significant. However, it was determined that there was no significant difference between the groups in terms of age, weeks of birth, prepartum and postpartum blood transfusion needs, 1st and 5th minute APGAR scores of infants, intraoperative and postoperative complications, and hospital stay. Conclusions: The incidence of hysterectomy increases as the number of previous cesarean sections increases in patients with placenta percreta.This situation increases the morbidity of the patients.Surgeons experienced in peripartum hysterectomy and uterine devascularization maneuvers are needed to achieve optimal results when the diagnosis of placenta percreta is made [ABSTRACT FROM AUTHOR]

INTRODUCTION: The purpose of this study is to investigate the predictive value of magnetic resonance imaging (MRI) parameters in predicting placenta accreta spectrum (PAS) and clinical outcomes of patients with placenta previa. METHODS: A total of 56 prenatal placental MRI examinations acquired via 1.5 and 3 Tesla scanners were retrospectively examined by 2 radiologists in consensus. Presence of T2 dark band, thinning of myometrium, abnormal vascularization, uterine bulging, heterogeneous placenta, placental protrusion, placenta recess and percretism findings were evaluated. While pathology and clinical intrapartum findings constituted the reference standard for placenta accreta spectrum (PAS), intrapartum/peripartum bleeding over 1000 mL and emergency hysterectomy were regarded as poor clinical outcomes. The values of MRI findings in predicting both PAS and clinical outcomes were analyzed. RESULTS: Age, platelet (PLT) value and gestational age were similar in patients with both groups. Signs of percretism had the best diagnostic test performance in predicting clinical worsening, followed by intraplacental abnormal vascularization and placental recession (respectively 80.6%, 76.4%, 73.6%). The most valuable finding in predicting PAS was percretism sign, placental recess, and myometrial thinning (respectively 85.0%, 81.3%, 79.4%). DISCUSSION AND CONCLUSION: Percretism and intraplacental abnormal vascularization are highly predictive of a possible poor clinical outcome.

Objective: To determine the incidence, indications, and maternal outcomes of emergency peripartum hysterectomy (EPH) at a tertiary setting in Ethiopia. Materials and methods: A 4‐year retrospective review of EPH cases was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from January 2016 to December 2019. Data were collected by reviewing maternal charts of EPH cases using a structured data extraction format. Stata Statistical Software, release 14, was used for data analysis. Frequency and percentages are used to present the significance of results. Results: Among 39 629 deliveries during the study period, there were 105 EPH, making the incidence rate 2.6 per 1000 deliveries. The common indications for EPH were uterine rupture (63/105; 60%), intractable uterine atony (23/105; 21.9%), and placenta accreta spectrum (14/105; 14.7%). The most common complications were anemia (85/105; 80.9%), puerperal fever (13/105; 12.4%), acute kidney injury (10/105; 9.5%), and relaparotomy (7/105; 6.7%). Conclusion: The incidence of EPH observed in our institution is high. Appropriate patient selection for vaginal delivery and strict labor follow up with early intervention for labor abnormalities should be the guiding principles of optimal obstetrical care to alleviate the burden of uterine rupture. Synopsis: The incidence of peripartum hysterectomy observed in our institution is high, with uterine rupture being the commonest indication. [ABSTRACT FROM AUTHOR]

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To describe and explore the risk factors, clinical presentations, timely diagnostic approaches, and management in patients experiencing unscarred uterine rupture with catastrophic hemorrhage. We retrospectively analyzed clinical and imaging data from women who encountered postpartum hemorrhage (PPH) and were diagnosed with unscarred uterine rupture within a three-year timeframe (2018-2020). The data were extracted from medical records obtained from a multi-hospital 24-hour emergency PPH transfer system. Six patients were identified as having unscarred uterine rupture after vaginal delivery. All six women were para 2, with four of them undergoing vacuum-assisted delivery. One patient experienced out-of-hospital cardiac arrest (OHCA), while five patients presented with hypovolemic shock. Abdominopelvic ultrasound revealed a boggy lower uterine segment. Initially, five patients underwent transarterial embolization (TAE) of the internal iliac arteries in an attempt to achieve hemostasis, but this approach proved unsuccessful. Abdominopelvic computed tomography (CT) confirmed the diagnosis of ruptured uterus by demonstrating disrupted myometrium and hemoperitoneum. Immediate exploratory laparotomy followed by life-saving hysterectomy was performed in all cases. The median estimated total blood loss was 2725 mL ± 900 mL (ranging from 1600 mL to 7100 mL). Lower segment lacerations were observed in all patients, with more extensive uterine damage noted in those who underwent vacuum extraction. The length of hospital stay varied between 9 and 38 days. Instrument-assisted obstetric delivery is a possible contributing factor to unscarred uterine rupture in our study. In specific cases, the use of abdominopelvic CT prior to initiating transarterial embolization (TAE) offers valuable information to complement ultrasound findings. This comprehensive approach helps in accurately identifying the underlying cause of intractable postpartum hemorrhage (PPH). Immediate conversion to laparotomy is essential to explore the intra-abdominal factors causing PPH that cannot be controlled by TAE. The rational etiologies of uterine rupture must be clarified while generating practical guideline in the future. [ABSTRACT FROM AUTHOR]

Objectives: To describe the simplicity, efficacy and safety of A. Chohan Continuous Squeezing Suture (ACCSS) for controlling haemorrhage from the lower uterine segment at caesarean section for placenta Praevia and accrete spectrum disorders. Methods: This prospective study was conducted on 47 patients with placenta Praevia and accreta spectrum disorders from February 2019 to May 2022 in two teaching hospitals of Lahore and ACCSS was applied. The outcome measures were peripartum hysterectomy procedure time, estimated blood loss, number of blood transfusions, duration of stay in the hospital, bladder trauma, uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage and maternal mortality. Descriptive statistics were calculated by using SPSS version 21. Results: Out of 47 patients, 7 (15%) had placenta creta, 29 (61.7%) increta, 11 (23.3%) percreta (grade 3a), and 36 (76.6%) central anterior dominant placenta. Peripartum hysterectomy was prevented in 97.8% of patients. ACCSS procedure time was 5-10 minutes (87.2%), with mean blood loss 2500±485 ml, mean blood transfusion 1.85±1.02 units and mean hospital stay of 3.3±0.84 days. One patient had bladder trauma. There was no case of uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage or maternal mortality. Conclusion: ACSS appears to be a simple, effective and safe treatment option for placenta praevia and accreta spectrum disorders, as an alternative to hysterectomy. [ABSTRACT FROM AUTHOR]

Gulzhanat Aimagambetova,1,&ast; Yesbolat Sakko,2,&ast; Arnur Gusmanov,2 Alpamys Issanov,2,3 Talshyn Ukybassova,4 Gauri Bapayeva,4 Aizada Marat,5 Aiymzhan Nurpeissova,6 Abduzhappar Gaipov2 1Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan; 2Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan; 3School of Population and Public Health, University of British Columbia, Vancouver, Canada; 4Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan; 5Department of Obstetrics and Gynecology #1, NJSC “Astana Medical University”, Nur-Sultan, Kazakhstan; 6Department of Medical Information Analysis of Outpatient and Polyclinic Care, The Republican Center of Electronic Healthcare, The Ministry of Healthcare of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan&ast;These authors contributed equally to this workCorrespondence: Gulzhanat Aimagambetova, Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khan’s Street 5/1, Nur-Sultan, 010000, Kazakhstan, Tel +7 7172 694645, Email gulzhanat.aimagambetova@nu.edu.kzPurpose: Peripartum hysterectomy is a surgical procedure performed as a life-saving surgery to manage severe postpartum hemorrhage. The prevalence of peripartum hysterectomy in high‐resource settings is relatively low. However, maternal mortality due to postpartum hemorrhage and after peripartum hysterectomy remains high in developing countries. To date, there is a lack of information about the rates of peripartum hysterectomy and its common indications in Kazakhstan. Objectives were to study the prevalence, indications, and outcomes of peripartum hysterectomy using nationwide large-scale health-care data from the national registry.Patients and Methods: We performed a descriptive, population‐based study among women who underwent a peripartum hysterectomy in any health-care setting of the Republic of Kazakhstan during the period of 2014– 2018. Data were collected from the Unified Nationwide Electronic Health System (UNEHS).Results: Data included 3838 medical records of women who had a peripartum hysterectomy performed due to specific indications for the period of 5 years (2014– 2018). The median age of the participants was 33 years old, with 60.7% of women aged between 18 and 34 years. The leading indications for peripartum hysterectomy were intrapartum hemorrhage (IPH) and postpartum hemorrhage (PPH) reported in 60% of the cases analyzed. The second most common indication was placental pathology – placental abruption and placenta previa in 9.6% and 7.9% of cases, respectively. In 1633 cases (42.4%), total abdominal hysterectomy was performed, while subtotal hysterectomy was done in 2195 cases (57.0%). Based on these data, the estimated prevalence of peripartum hysterectomies was calculated: overall weighted mean prevalence 1.93 per 1000 deliveries.Conclusion: IPH and PPH are the commonest indications for peripartum hysterectomy followed by placental pathology. Appropriate maternal care during labor and delivery should be reinforced to decrease the incidence of peripartum hysterectomy in Kazakhstan.Keywords: postpartum hemorrhage, maternal mortality, peripartum hysterectomy, epidemiology, Kazakhstan

Abstract Objective To compare the outcomes of emergency and planned peripartum hysterectomies. Methods The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies. Results A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p=0.014), and higher postoperative hemoglobin levels (9.9±1.3 versus 8.3±1.3; p

Introduction: A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies. Material and methods: Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy. Results: The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications). Conclusions: The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of the implementation of a multilevel institutional program to reduce the rate of emergency peripartum hysterectomy (EPH) secondary to postpartum haemorrhage (PPH) in a Western world referral centre for obstetrics.Study Design: Women who delivered at a tertiary care regional obstetric hub in Milan between 2012 and 2020 were retrospectively reviewed to identify cases of EPH. During the study period, several measures aimed at preventing EPH were progressively implemented: reduction of primary and repeated caesarean, update of PPH treatment protocol, implementation of massive transfusion protocol, dedicated clinical pathway for high-risk patients, regular educational sessions, daily review of critical cases with senior consultant, and periodical review of near miss cases by quality improvement committee. To investigate the possible benefits, we divided the detected cases into two groups based on the historical period (Period I, 2012-2016 vs. Period II, 2017-2020) with the main aim of comparing the rate of EPH calculated as EPH ratio per 1000 deliveries.Results: During Period I and II there were 30,241 and 21,270 births; a total of 60 and 25 EPH were performed, respectively. EPH incidence decreased from 2.0 to 1.2‰ across the study periods (p = 0.027). Between Period I and II, we observed a reduction of institutional caesarean section rate (44.4% vs. 40.4%, p < 0.0001); among cases undergoing EPH, we reported a significant reduction of massive blood transfusion (83.3% vs. 52.2%, p = 0.002), increased use (56.7% vs. 96.0%, p = 0.0004) and appropriate administration (25.0% vs. 88.0%, p < 0.0001) of tranexamic acid, increased use of non-invasive Bakri Balloon tamponade (3.3% vs. 32.0%, p = 0.0002) instead of surgical techniques (38.3% vs. 16.0%, p = 0.043).Conclusion: A reduction of EPH incidence as a severe outcome of obstetric haemorrhage is achievable through a multilevel institutional effort. Our study may inspire a larger-scale program to improve the safety of patients experiencing PPH. [ABSTRACT FROM AUTHOR]

Objective: To identify changing trends in peripartum hysterectomy (PH), both elective.cesarean hysterectomy and emergency cesarean hysterectomy, at a single training and research hospital over the last 17 years in Istanbul, Turkey. Materials and methods: A retrospective cohort study was performed between January 2001 and September 2017. The records of all patients who had PH at Kanuni Sultan Süleyman Training and Research Hospital were analyzed. Results: There were 243 cases of PH during the study period. A total of 266,386 births occurred, of which 60.1% were vaginal deliveries and 39.8% were cesarean sections. The incidence of PH increased from 0.67 per 1000 deliveries to 1.14 per 1000 deliveries during 2001–2008 and 2009–2017, respectively, with an overall incidence of 0.91 per 1000 deliveries during the 17 years. The main indication for PH changed significantly during this time from uterine atony (57.1%) to placenta accreta spectrum (85%). About 37% of women who underwent PH had at least one previous cesarean delivery during 2001–2008, whereas that percentage increased to 95.4% during 2009–2017. Conclusion: Placenta accreta spectrum was the leading cause of PH and was associated with significant maternal morbidity and mortality.

BackgroundThe distinguished Triple-P procedure has been reported as a conservative surgical alternative to peripartum hysterectomy for placental accreta spectrum (PAS). In this study, we modified the procedure combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet and evaluated the effect and long-term outcomes.MethodsThis was a retrospective study involving pregnant patients with clinically confirmed severe PAS (including placenta increta and percreta) between January 1st, 2017 and June 30th, 2020 in the First Affiliated Hospital of Zhengzhou University. A total of 334 pregnant women were recruited in this study. The 142 women that were subjected to modified Triple P Procedure were regarded as the observation group while 194 pregnant women that were treated with other sutures were regarded as the control group. Demographic characteristics, placental accreta spectrum score (PAS score), estimated blood loss (EBL), operative time, blood transfusion rate and volume, neonatal weight, post-operative hospital stays and costs were evaluated. Short-term complications, including fever, hematoma, thrombus, bladder rupture and intensive care unit (ICU) transfer rate, as well as long-term outcomes including breast feeding, menstruation, intrauterine adhesion, and chronic abdominal pain among others were followed up in the outpatient clinic and by phone calls.ResultsFor all cases, EBL was lower in the observation group than in the control group, 1,200 (687–1,812) ml and 1,300 (800–2,500) ml, respectively. The difference was statistically significant (P < 0.05). Operative time were statistically significantly shorter in the observation group [99.5 (84.0–120.0) min and 109.0 (83.8–143.0) min, P < 0.05]. Lengths of postoperative hospital stays were 4 (4–7) and 5 (4–7) days in the observation and control group, which was significantly shorter in the observation group (P < 0.05). There were no significant differences in PAS scores, blood transfusion volume, neonatal weight, fever, hematoma, thrombus, bladder rupture and ICU transfer rates between the two groups. All patients, except one in control group, had preserved uterus. There were no statistically significant differences in short-term and long-term complications between two groups.ConclusionIn summary, when combined with tourniquet and/or prophylactic abdominal aorta balloon occlusion, modified Triple-P procedure may be effective in reducing intraoperative blood loss and hysterectomy in patients with placenta increta/percreta. It is a safe and effective surgical alternative to peripartum hysterectomy. However, the complications associated with interventional radiology service should be evaluated furthermore.

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Peripartum hysterectomy (PH) is usually undertaken in cases of life-threatening obstetric haemorrhage to prevent the death of the mother. Obstetric haemorrhage, a leading indication for PH, is a major cause of maternal deaths globally, particularly in regions with limited access to advanced medical care. The cause of the per vaginal bleeding was due to the patient in labour with a cervical stitch, and immediate action was taken in the form of a lower segment caesarean section. After the patient's abdominal drain is noticed with fresh blood collection, an emergency obstetric hysterectomy is done., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Naga Rachana et al.)

Objective  This study aimed to determine whether race and ethnicity contribute to risks associated with peripartum hysterectomy. Study Design  This retrospective cross-sectional study utilized the 2000–2014 Nationwide Inpatient Sample to analyze risk of peripartum hysterectomy and associated severe maternal morbidity, mortality, surgical injury, reoperation, surgical-site complications, and mortality by maternal race and ethnicity. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, other, and unknown. Multivariable log-linear regression models including patient, clinical, and hospital risk factors were performed with adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results  Of 59,854,731 delivery hospitalizations, there were 45,369 peripartum hysterectomies (7.6 per thousand). Of these, 37.8% occurred among non-Hispanic white, 13.9% among non-Hispanic black, and 22.8% among Hispanic women. In adjusted analyses, non-Hispanic black (aRR: 1.21, 95% CI: 1.17–1.29) and Hispanic women (aRR: 1.25, 95% CI: 1.22–1.29) were at increased risk of hysterectomy compared with non-Hispanic white women. Risk for severe morbidity was increased for non-Hispanic black (aRR: 1.25, 95% CI: 1.19–1.33), but not for Hispanic (aRR: 1.02, 95% CI: 0.97–1.07) women. Between these three groups, risk for intraoperative complications was highest among non-Hispanic white women, risk for reoperation was highest among Hispanic women, and risk for surgical-site complications was highest among non-Hispanic black women. Evaluating maternal mortality, non-Hispanic black women (RR: 3.83, 95% CI: 2.65–5.53) and Hispanic women (RR: 2.49, 95% CI: 1.74–3.59) were at higher risk than non-Hispanic white women. Conclusion  Peripartum hysterectomy and related complications other than death differed modestly by race. In comparison, mortality differentials were large supporting that differential risk for death in the setting of this high-risk scenario may be an important cause of disparities. Key Points Peripartum hysterectomy and related complications differed modestly by race. Mortality differentials in the setting of peripartum hysterectomy were large. Failure to rescue may be an important cause of peripartum hysterectomy disparities. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of uterine rupture (UR), and evaluate risk factors, management, and associated maternal and perinatal outcomes.Study Design: This multicentre prospective population-based study involved six regions in Italy accounting for 49% of national births. The study population comprised all women aged 11-59 years delivering at ≥22 gestational weeks with a diagnosis of UR from September 2014 to August 2016. Maternal and pregnancy characteristics and information on potential risk factors were collected. Unadjusted relative risks (RR) and 95% confidence intervals (CI) were computed with respect to the background population.Results: In total, 74 cases of UR occurred among the study population (rate 0.16/1000 pregnancies; mean age 34 years; 14 perinatal deaths, one maternal death). A significantly higher risk of UR was observed for maternal age ≥ 35 years (RR = 1.58, 95% CI 1.00-2.51), multiparity (RR = 5.71, 95% CI 3.14-10.04), previous caesarean section (RR = 20.5, 95% CI 11.11-37.74) and uterine scarring (RR = 6.44, 95% CI 2.94-14.12). A significant association was observed between UR and caesarean section as the mode of delivery (RR = 27.9, 95% CI 10.2-76.5) and gestational age < 37 weeks (RR = 11.82, 95% CI 7.46-18.71).Conclusions: This study found a low rate of UR compared with other European countries, probably due to the high rate of primary caesarean sections and to resistance towards trial of labour and vaginal delivery after caesarean section among obstetricians in Italy. The unforeseen increase in caesarean sections -and, as a result, an increase in placenta accreta spectrum disorders, peripartum hysterectomy and related maternal and perinatal morbidity and mortality as a consequence of previous uterine scarring - failed to ensure better maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Abnormal Low Lying Implantation of Ectopic Pregnancy (LLIEP) may occur in cervix, cervico isthmic region or caesarean scar. Cervicoisthmic pregnancy remains the rarest form of LLIEP, a life threatening cause of maternal morbidity and mortality with an incidence of 1 in every 2400 to 4500 pregnancies. In isthmic implantation, the gestational sac is located more cranially and between the cervix distally and the decidualised functional endometrium cranially. Transvaginal Ultrasound (TVS), Colour Doppler and Magnetic Resonance Imaging (MRI) remain gold standard modalities for early diagnosis. Ultrasonography depicts bulging lower uterine segment with a normal cervical length and consistency. Here, the author reports a rare case of ruptured isthmic pregnancy with 20 weeks intrauterine foetus death lying in left broad ligament in a 33-year-old unbooked G3 P2 L2 with gestation of 31 weeks presenting in emergency. Ultrasonography depicted intrauterine foetus death with foetus lying in lower segment of uterus. Lower section caesarean section for failed induction confirmed hour glass uterus with empty upper uterine segment and bulging, distended, couvelaire lower uterine segment and left lateral rupture at cervicoisthmic junction. Dead 20 weeks foetus lying in leaves of left broad ligament. Peripartum hysterectomy was done as a life saving procedure. Cervicoisthmic pregnancy is rarest form of LLIEP and diagnosis may result in rupture with need 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. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage remains one of the principal causes of maternal mortality in the United States and throughout the world. Its management, which must be multidisciplinary (obstetrics, midwifery, anesthesiology, interventional radiology, and nursing), depends on the speed of both diagnosis and implementation of medical and surgical treatment to control the hemorrhage. The aim of this work is to describe the various techniques of vessel ligation and of uterine compression for controlling and treating severe hemorrhage, and to present the advantages and disadvantages of each. It is not difficult to perform vessel ligation of the uterine arteries: O'Leary's bilateral ligation of the uterine artery, Tsirulnikov's triple ligation, and AbdRabbo's stepwise uterine devascularization (that is, stepwise triple ligation). These procedures are associated with a high success rate (approximately 90%) and a low complication rate. Bilateral ligation of the internal iliac (hypogastric) arteries is more difficult to perform and potentially less effective (approximately 70% effectiveness) than the previously mentioned procedures. Its complication rate is low, but the complications are most often serious. There is no evidence that future fertility or subsequent obstetrical outcomes are impaired by ligation of either the uterine or internal iliac arteries. There are many techniques used for uterine compression sutures, and none has shown clear superiority to another. Uterine compression suture has an effectiveness rate of approximately 75% after failure of medical treatment and approximately 80% as a second-line procedure after unsuccessful vessel ligation. The risk of synechiae after uterine compression suture has not yet been adequately evaluated, but is probably around 5%. The risk of synechiae after uterine compression suture has not yet been adequately evaluated, but probably ranges between 5% and 10%. The methodologic quality of the studies assessing uterine-sparing surgical procedures remains limited, with no comparative studies. Accordingly, no evidence suggests that any one of these methods is better than any other. Accordingly, the choice of surgical technique to control hemorrhage must be guided firstly by the operator's experience. If the hemorrhage continues after a first-line uterine-sparing surgical procedure and the patient remains hemodynamically stable, a second-line procedure can be chosen. Nonetheless, the application of these procedures must not delay the performance of a peripartum hysterectomy in cases of hemodynamic instability. [ABSTRACT FROM AUTHOR]

Purpose: To define the frequency, significant factors and causes that necessitated peripartum hysterectomies. Material and Methods: We studied retrospectively and prospectively 21 patients who underwent peripartum hysterectomies at “Nadezhda” Women’s Health Hospital between January 2013 and July 2019. Results: The frequency of peripartum hysterectomy was 1.96/1000 deliveries, and 95 % of them were performed during or after a cesarean birth. The intrapartum ones were carried out mainly because of uterine atony or abnormal insertion of the placenta. The interventions made in the early postoperative period were undertaken in cases of severe pelvic inflammations and postoperative hematomas. Conclusion: Patients undergoing cesarean section are at risk for peripartum haemorrhages, which are associated with many risk factors: previous cesarean section and other interventions such as myomectomy, placenta praevia.

Objective: To develop and validate a model to predict the incidence of emergency peripartum hysterectomy (EPH) due to postpartum haemorrhage (PPH) from the time of delivery to 6 weeks postpartumin the duration of caesarean section (C-section). Methods: There were 627 patients with PPH including in this retrospective study from 2015 to 2019. Among these patients, 439 patients were divided into the model development group and 188 patients were divided into the validation group. The validation group was constructed for external validation in the usage of bootstrap resampling. The least absolute shrinkage and selection operator (LASSO) regression model was used to reduce the data dimension, and select features and independent risk factors. Results: In total, the incidence rate of PPH and EPH was 7.53% (2145/284,912) and 2.73‰ (78/28,491) among the 28,491 patients with C-section, respectively. The results of LASSO regression indicated that prothrombin time decrease at 60 minutes after C-section (odds ratio (OR) = 1.823, 95% confidence interval (CI): 1.171–2.839) and placenta previa (OR = 5.374, 95% CI: 2.751–10.393) were positively associated with EPH in this study, while gestational age at termination (OR = 0.959, 95% CI: 0.930–0.989) and albumin decrease at 60 minutes after C-section (OR = 0.907, 95% CI: 0.843–0.976) had negative association with EPH. Besides, we found that the C-index was 0.896 for the primary cohort and 0.899 for the validation cohort in the prediction nomogram, respectively. Conclusions: In this retrospective study, an EPH nomogram within several risk factors, which was constructed by LASSO regression, can be contributed to effectively predict the risk of EPH in patients with PPH during C-section. In addition, a significant association is observed between abnormal placenta and peripartum hysterectomy.

Background: The overall annual incidence of caesarean delivery in Pakistan has been steadily rising over the past two decades from 14% in 2012-13 to 22% in 2017-18. Primary caesarean often leads to repeat caesareans, which may result in increased chances of morbid adherence of placenta. Now it has become proportionally a major cause of maternal morbidity and mortality. Objective: To determine the frequency, major indication of surgery, mortality and morbidities associated with obstetric hysterectomies at a tertiary care hospital. Study type settings & duration: The retrospective descriptive study was conducted in Gynaecology and Obstetrics unit I of Jinnah Hospital Lahore over a period of four years from January 2016 to December 2019. All cases of obstetric hysterectomy during this time were included in this study. Methodology: Medical records of all pregnant admitted patients for delivery requiring an emergency peripartum hysterectomy (EPH) were included. All files were reviewed for key variables to be evaluated. Each case record was studied in detail for variables like indications, maternal profile, type of operation performed, maternal morbidity and mortality. The data was analyzed using SPSS version 21.0 and data was presented as frequencies and percentages. Results: A total of 96 women underwent obstetric hysterectomy during study period. Out of these 60% had morbid adherence of placenta making it the commonest indication of hysterectomy. Women with previous cesarean section had higher risk of obstetric hysterectomy (73%) than those who had vaginal delivery (27%). Highest incidence found among grand multigravidas, in age group of 30-39 years.........

Aims: To find out the incidence, indications, complication of emergency peripartum hysterectomy in a tertiary care center. Methods: This was a retrospective study conducted over a period of 18 months from April 2017 to October 2018 at Paropakar Maternity and Women’s Hospital in Kathmandu. Data were obtained from the operation theater register and record section. Results: Out of 30917 deliveries in 18 months 18 had lifesaving emergency peripartum hysterectomy (0.58 per 1000 deliveries). The most common indication being morbidly adherent placenta/placenta previa (8; 44%) followed by ruptured uterus (5; 28%), uterine atony (4; 22%). The most common risk factor is attributed to previous cesarean section (11; 61%) followed by abnormal placentation (7; 39%). Most common morbidity was febrile morbidity followed by wound infection and bladder injury. Conclusion: Abnormal placentation and past cesarean section contributed to be the major indication of peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

The objective of this study is to assess the 10-year incidence of peripartum hysterectomy that was performed in the province of Van, Turkey, as well as its clinical results. In this study, we retrospectively examined all patients who underwent peripartum hysterectomy, which was performed at Van Yuzuncu Yil University Dursun Odabas Medical Center between 2010 and 2020. 99 patients who underwent hysterectomy due to severe bleeding, which could not be stopped despite conservative treatments within 24 hours following the delivery, were included in the study. The overall rate of peripartum hysterectomy was 99 of 22242 or 4.4 per 1,000 deliveries. The mean maternal age was 31.98 ± 5.41 years. The most common indications for peripartum hysterectomy are placental adhesion disorders (70.7%), uterine atony (25.2%), and uterine rupture (4%). Ultimately, the most common indication for peripartum hysterectomy is placental adhesion disorders. The rise in the number of cesarean section might have increased the incidence of placental adhesion disorders. Thus, patients should be provided with healthcare in centers that have adequate equipment and staff. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics and outcomes of prelabour uterine ruptures. Design: Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Sample: Maternities with uterine rupture before start of labour in Norway during the period 1967–2008 (8 complete ruptures among 2 334 712 women with unscarred uteri, and 22 complete and 45 partial ruptures among 121 085 women with scarred uteri). Method: We measured the rate of perinatal deaths and peripartum hysterectomy following ruptures. In addition, we studied the characteristics of ruptures. Results: The eight complete ruptures in women with unscarred uteri were associated with trauma from traffic accidents (n = 3; 37.5%), previous curettage (n = 3; 37.5%) and congenital uterine malformations (n = 2; 25%), resulting in seven perinatal deaths and two hysterectomies. The 22 complete ruptures in scarred uteri were mostly outside the lower uterine segment (n = 17; 72.7%). Abnormally invasive placenta (AIP) and previous rupture were present in four (18.2%) and three women (13.6%), respectively. They resulted in nine perinatal deaths (39.1%) and two hysterectomies (9.1%). The 45 partial ruptures involved mostly scars in the lower uterine segment (n = 39; 86.7%). None of them resulted in perinatal death or hysterectomy. Perinatal deaths have decreased dramatically in recent years, despite increasing prelabour rupture rates. Conclusion: Although complete uterine ruptures before labour start were rare, they often resulted in catastrophic outcomes, such as perinatal death. Scars outside the lower segment were associated with a higher percentage of catastrophic prelabour ruptures compared with scars in the lower segment (Video S1). Complete prelabour uterine ruptures were rare, but resulted in high perinatal deaths, especially if they were in scars outside the lower segment. Complete prelabour uterine ruptures were rare, but resulted in high perinatal deaths, especially if they were in scars outside the lower segment. This article includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights16363 [ABSTRACT FROM AUTHOR]

Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.

Abstract Background Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. Methods We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. Results Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7–3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6–5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9–1.7). Conclusions Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia.

Background: The incidence of Placenta Accreta Spectrum (PAS) is increasing. This study explores women's personal experience of a pregnancy, birth and early postpartum period complicated by PAS.Methods: A qualitative study involving seven women (age range: 33-44 years) following a pregnancy in the previous two years complicated by PAS was conducted. Using an Interpretative Phenomenological Analysis approach data were collected and analysed in 2019 and 2020 through face-to-face interviews. Interviews were transcribed verbatim.Results: Women described their experience from diagnosis up to two years following the birth and focussed on the strategies they used to cope with an unexpected diagnosis of PAS. Six main themes emerged. In pregnancy, women were focussed on the diagnosis and managing family life from hospital "it's not until you are told", "sad but safe", "relying on others can be unbearable". In terms of the birth a 'fear of dying' related to self and baby was central. Postnatally key themes related to the ongoing consequences of the condition as "no one believed I could be feeling so much pain" and "it's not all over when you go home".Discussion: Women who have experienced a pregnancy complicated by PAS experience significant challenges associated with long term hospitalization, post-operative pain and many express feelings of being generally worried lasting many months after their pregnancy. This study makes an important contribution to the growing body of research in PAS, namely that of the woman's own voice. [ABSTRACT FROM AUTHOR]

Background: The overall annual incidence of caesarean delivery in Pakistan has been steadily rising over the past two decades from 14% in 2012-13 to 22% in 2017-18. Primary caesarean often leads to repeat caesareans, which may result in increased chances of morbid adherence of placenta. Now it has become proportionally a major cause of maternal morbidity and mortality. Objective: To determine the frequency, major indication of surgery, mortality and morbidities associated with obstetric hysterectomies at a tertiary care hospital. Study type settings & duration: The retrospective descriptive study was conducted in Gynaecology and Obstetrics unit I of Jinnah Hospital Lahore over a period of four years from January 2016 to December 2019. All cases of obstetric hysterectomy during this time were included in this study. Methodology: Medical records of all pregnant admitted patients for delivery requiring an emergency peripartum hysterectomy (EPH) were included. All files were reviewed for key variables to be evaluated. Each case record was studied in detail for variables like indications, maternal profile, type of operation performed, maternal morbidity and mortality. The data was analyzed using SPSS version 21.0 and data was presented as frequencies and percentages. Results: A total of 96 women underwent obstetric hysterectomy during study period. Out of these 60% had morbid adherence of placenta making it the commonest indication of hysterectomy. Women with previous cesarean section had higher risk of obstetric hysterectomy (73%) than those who had vaginal delivery (27%). Highest incidence found among grand multigravidas, in age group of 30-39 years. Conclusion: Morbidly adherent placenta is one of the leading causes of obstetric hysterectomy. Rising caesarean section rate is one of the major risk factor for surgery. Incidence of cesarean section can only be reduced by health education, provision of quality antenatal care, early referral of high-risk cases and implementation of evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Objective: To compare perioperative outcomes by patient race/ethnicity.Methods: A retrospective cohort study identified 7 331 638 childbirth hospitalizations for women aged 12-55 years 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.Results: 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.Conclusion: Women of color have higher rates of peripartum hysterectomy and experience higher rates of poor perioperative outcomes and mortality. [ABSTRACT FROM AUTHOR]