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Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study
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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9564671/ https://www.ncbi.nlm.nih.gov/pubmed/35388907 http://dx.doi.org/10.1111/aogs.14358 |
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author | Pettersen, Silje Falk, Ragnhild Sørum Vangen, Siri Nyfløt, Lill T. |
author_facet | Pettersen, Silje Falk, Ragnhild Sørum Vangen, Siri Nyfløt, Lill T. |
author_sort | Pettersen, Silje |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9564671 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-95646712022-12-06 Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study Pettersen, Silje Falk, Ragnhild Sørum Vangen, Siri Nyfløt, Lill T. Acta Obstet Gynecol Scand Birth 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. John Wiley and Sons Inc. 2022-04-07 /pmc/articles/PMC9564671/ /pubmed/35388907 http://dx.doi.org/10.1111/aogs.14358 Text en © 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Birth Pettersen, Silje Falk, Ragnhild Sørum Vangen, Siri Nyfløt, Lill T. Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study |
title | Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study |
title_full | Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study |
title_fullStr | Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study |
title_full_unstemmed | Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study |
title_short | Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital‐based study |
title_sort | peripartum hysterectomy due to severe postpartum hemorrhage: a hospital‐based study |
topic | Birth |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9564671/ https://www.ncbi.nlm.nih.gov/pubmed/35388907 http://dx.doi.org/10.1111/aogs.14358 |
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