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Published on: January 17, 2019
Emergency obstetric hysterectomy - an increasing incidence
D A Gould1, S A Butler-Manuel, M J Turner
1Department of Obstetrics and Gynaecology, St George's Hospital, London, UK.
Summary
Obstetric hysterectomy, an emergency procedure for postpartum hemorrhage, is increasingly linked to abnormal placentation, especially after C-sections. Early ultrasound identification of high-risk cases can aid pre-operative counseling.
Area of Science:
- Obstetrics and Gynecology
- Surgical Outcomes
- Maternal Health
Background:
- Obstetric hysterectomy rates show a significant increase.
- Emergency hysterectomies are often necessitated by postpartum hemorrhage.
- Abnormal placentation is a primary indication for this procedure.
Purpose of the Study:
- To analyze the incidence and indications of obstetric hysterectomy.
- To investigate the association between previous Cesarean section and abnormal placentation.
- To evaluate the outcomes and complications of emergency obstetric hysterectomy.
Main Methods:
- Retrospective case review of ten obstetric hysterectomies performed between 1992-1998.
- Analysis of indications, surgical complications, and patient outcomes.
- Correlation of abnormal placentation with prior Cesarean sections.
Main Results:
- Nine out of ten cases were emergency procedures for massive postpartum hemorrhage.
- Abnormal placentation, frequently associated with previous Cesarean section, was the leading cause.
- No maternal or fetal deaths occurred, but one case had significant surgical complications.
Conclusions:
- There is a rising trend in obstetric hysterectomy, particularly in women with abnormal placentation post-Cesarean section.
- Ultrasound can identify high-risk pregnancies for abnormal placentation.
- Pre-operative counseling is crucial for managing risks associated with peripartum hysterectomy.
