<- Home <- Arhive <- Vol. 7, Issue 1, February 2011

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Obstetric Hysterectomy – patient’s profile in a tertiary obstetrical unit

Abstract: Assessment of patients’ profile with post partum hysterectomy. A 8 years retrospective study (2001-2008), conducted in a tertiary referral obstetrical unit, “Dr. Ion Cantacuzino” Clinical Hospital, Bucharest, with the analysis of the relationship between patient’s history and pregnancy outcome and hysterectomy indication. There were 19388 births (15745 vaginal deliveries (79.81%), 3913 cesarean sections (CS) (20.18%)), no maternal death. Hysterectomy was performed in 19 cases (0.98/1000 obstetric ca ses), 7 nulliparas (36.84%) and 12 multipara (63.15%). Unilateral adnexectomy (UA) was performed in 5 cases. Week end obstetric hysterectomies (WOH, i.e. performed in week end) were 12 (63.15%). Indication for hysterectomy was uterineatony (7 cases, 36.84%), placenta accreta (7 cases, 36.84%), uterine rupture (2 cases, 10,52%), vaginal haematoma, vascular fis tu la after cesarean sect ion and uterine myoma (1 case each, 5.26%). Six cases (31.57%) were considered preventable obstetric hysterectomies (POH): 2 cases of uterine rupture, 2 cases of uterine atony after vaginal delivery, 1 case of vaginal haematoma and 1 case of vascular fistula after cesarean section. POH followed vaginal de livery, respectively CS, in 80%, respectively 14.29%, p= 0.0072. POHs represent 100% of WHs, compared with 46.15% during week; p = 0.0237. WH was associated with severe intraoperative complications in 41.66% cases, compared with 0% during week, p = 0.0466. Fetus was dead (ante- or intrapartum) in 4 patients with severe intraoperative complications (57,14%), compared with one fetal death in patients with out severe intraoperative com plications (8.33%); p = 0.0198. UA was performed only non-monitored patients (5 cases out of 11; 45.45%), compared with 0% in monitored patients (p = 0.0263). UA was necessary in 5 cases (71.43%) with dead fetus, compared with 0% when fetus was alive; p = 0.0006. Mean haemoglobin loss was 5.52 g/dL in POH, greater than 3.1 g/dL in non-POH; p = 0.0448. Post partum hysterectomy is a week end drama, performed on a multipara, with neglected labour, non-monitored; fetal death and ad nexectomy could serve as a retrospective marker of severity.
Keywords: postpartum hysterectomy, obstetric hysterectomy, uterine atony

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