Emergency postpartum hysterectomy in Maharat Nakhon Ratchasima Hospital: clinical characteristic and risk factors
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Abstract
Background: Postpartum hemorrhage remains a leading cause of maternal death. Although there has been improved of various treatment, such as prostaglandin, uterine tamponade and -Lynch suture. However some women do not respond to these treatments and need Emergency postpartum hysterectomy (EPH) for control intractable bleeding. Many studies had addressed this serious life-threatening condition with inconclusive risk factors. The aim of this study is to determine clinical characteristic that associated with EPH in Maharat Nakhon Ratchasima Hospital.
Objective: To determine the incidence, indications and factors influencing EPH.
Design: A retrospective hospital-based descriptive and case control study.
Setting: Department of Obstetrics and Gynecology, Maharat Nakhon Ratchasima Hospital.
Methods and materials: Cases of EPH carried out within 24 hours after delivery at Maharat Nakhon Ratchasima Hospital during January 2001 and December 2009 were identified from labor registration records. We reviewed their medical records to assess for the following outcome (1) incidence of EPH (2) indication for EPH (3) Factors that association with EPH (4) complication after EPH. Women who gave birth before (2 cases) and after (2 cases) the case of EPH were the control using to assess the risk factors association with EPH.
Result: Among 74,925 deliveries after 28 weeks gestational age during January 2001 and December 2009, 124 cases underwent EPH giving an incidence 1.65:1000 deliveries. Medical records were available for 117 cases. Placenta adherent (58.12%) was the most common indication of EPH followed by uterine atony (32.48%) and uterine rupture (9.4%). The significant risks factors affecting EPH by multivariate logistic regression analysis were maternal age > 35 years, multiparity, placenta abruption, placenta previa, preeclampsia, vacuum extraction and cesarean delivery. When devied patients by indication for EPH the “adherent” group had a previous cesarean delivery 69.1%, placenta previa 66.2% higher than “atony” and “rupture” groups. In the “atony” and “rupture” groups had preclampsia 29% and 36.4%, abruption placenta 15.8% and 18.2% higher than the “adherent” groups. The complications were mostly found in “adherent” group. 1 had bladder injury and another 2 had bowel injury. In the “adherent” group EPH were mostly performed at the time of cesarean section 83.8%. The “atony” group EPH were mostly performed after vaginal delivery 39.5% and 34.2% had coagulopathy. There were three maternal death. All of them were “atony” group with coagulopathy. Duration for EPH after vaginal delivery were 230, 250 and 360 minutes respectively.
Conclusions: Incidence of EPH is not uncommon in the modem obstetric practice of increasing elderly pregnancy and cesarean section rate.
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