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DOI: 10.1055/s-0040-1721354
Peripartum Hysterectomies over a Fifteen-year Period
Histerectomias periparto ao longo de um período de quinze anosAbstract
Objective To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure.
Methods A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019.
Results The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, and we found no difference between total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age.
Conclusion Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.
Resumo
Objetivo Determinar as indicações e os desfechos das histerectomias periparto realizadas no Hospital de Clínicas de Porto Alegre nos últimos 15 anos, bem como analisar as características clínicas das mulheres submetidas a esse procedimento.
Métodos Estudo transversal de 47 histerectomias periparto realizadas no período de 2005 a 2019.
Resultados Em nosso hospital, as histerectomias periparto foram indicadas principalmente por acretismo placentário ou sua suspeita (44,7% dos casos), hemorragia puerperal sem acretismo placentário (27,7%), e infecção (25,5%). Histerectomias totais corresponderam a 63,8% dos casos, e não encontramos diferença entre histerectomia total e subtotal para os desfechos estudados. A maioria das histerectomias foi realizada dentro de 24 horas após o parto, o que estava associado a acretismo placentário, placenta prévia, e idade materna mais avançada.
Conclusão A maioria (66,0%) das mulheres necessitou de internação em unidade de terapia intensiva (UTI); aquelas que não necessitaram eram significativamente mais velhas, e tinham mais acretismo placentário, placenta prévia, ou cesárea prévia.
Contributors
All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.
Publication History
Received: 01 April 2020
Accepted: 30 September 2020
Article published online:
29 January 2021
© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Durfee RB. Evolution of cesarean hysterectomy. Clin Obstet Gynecol 1969; 12 (03) 575-589 DOI: 10.1097/00003081-196909000-00002.
- 2 Davis ME. Complete cesarean hysterectomy; a logical advance in modern obstetric surgery. Am J Obstet Gynecol 1951; 62 (04) 838-853 DOI: 10.1016/0002-9378(51)90174-3.
- 3 van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KW. Prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy worldwide: a systematic review and meta-analysis. Obstet Gynecol 2016; 128 (06) 1281-1294 DOI: 10.1097/AOG.0000000000001736.
- 4 de la Cruz CZ, Thompson EL, O'Rourke K, Nembhard WN. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review. Arch Gynecol Obstet 2015; 292 (06) 1201-1215 DOI: 10.1007/s00404-015-3790-2.
- 5 Rossi AC, Lee RH, Chmait RH. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol 2010; 115 (03) 637-644 DOI: 10.1097/AOG.0b013e3181cfc007.
- 6 Bateman BT, Mhyre JM, Callaghan WM, Kuklina EV. Peripartum hysterectomy in the United States: nationwide 14 year experience. Am J Obstet Gynecol 2012; 206 (01) 63.e1-63.e8 DOI: 10.1016/j.ajog.2011.07.030.
- 7 Whiteman MK, Kuklina E, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, Marchbanks PA. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol 2006; 108 (06) 1486-1492 DOI: 10.1097/01.AOG.0000245445.36116.c6.
- 8 Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. United Kingdom Obstetric Surveillance System Steering Committee. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 2008; 111 (01) 97-105 DOI: 10.1097/01.AOG.0000296658.83240.6d.
- 9 Kacmar J, Bhimani L, Boyd M, Shah-Hosseini R, Peipert J. Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study. Obstet Gynecol 2003; 102 (01) 141-145 DOI: 10.1016/s0029-7844(03)00404-6.
- 10 Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol 2009; 114 (01) 115-123 DOI: 10.1097/AOG.0b013e3181a81cdd.
- 11 Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177 (01) 210-214 DOI: 10.1016/s0002-9378(97)70463-0.
- 12 Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (06) 1226-1232 DOI: 10.1097/01.AOG.0000219750.79480.84.
- 13 Knight M. UKOSS. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG 2007; 114 (11) 1380-1387 DOI: 10.1111/j.1471-0528.2007.01507.x.
- 14 Wright JD, Devine P, Shah M, Gaddipati S, Lewin SN, Simpson LL. et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol 2010; 115 (06) 1187-1193 DOI: 10.1097/AOG.0b013e3181df94fb.
- 15 Shellhaas CS, Gilbert S, Landon MB, Varner MW, Leveno KJ, Hauth JC. et al; Eunice Kennedy Shriver National Institutes of Health and Human Development Maternal-Fetal Medicine Units Network. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol 2009; 114 (2 Pt 1): 224-229 DOI: 10.1097/AOG.0b013e3181ad9442.
- 16 Cheng HC, Pelecanos A, Sekar R. Review of peripartum hysterectomy rates at a tertiary Australian hospital. Aust N Z J Obstet Gynaecol 2016; 56 (06) 614-618 DOI: 10.1111/ajo.12519.
- 17 Imudia AN, Hobson DT, Awonuga AO, Diamond MP, Bahado-Singh RO. Determinants and complications of emergent cesarean hysterectomy: supracervical vs total hysterectomy. Am J Obstet Gynecol 2010; 203 (03) 221.e1-221.e5 DOI: 10.1016/j.ajog.2010.04.007.
- 18 Eller AG, Bennett MA, Sharshiner M, Masheter C, Soisson AP, Dodson M, Silver RM. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117 (2 Pt 1): 331-337 DOI: 10.1097/aog.0b013e3182051db2.
- 19 Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 2014; 121 (01) 62-70, discussion 70–71 DOI: 10.1111/1471-0528.12405.
- 20 Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009; 116 (05) 648-654 DOI: 10.1111/j.1471-0528.2008.02037.x.