DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20211337

Determine the frequency of peripartum hystrectomy in placenta previa

Amna Usman, Quratulain Shabbir, Falak Naz, Attiya Yasmeen, Mubashra Naz, Sanober Faisal

Abstract


Background: Peripartum hysterectomy is one of the life saving procedure performed after vaginal delivery or caesarean birth or in the immediate postpartum period in cases of intractable haemorrhage due to uterine atony, rupture uterus and placental disorders and it is usually reserved for the situations where conservative measures fail to control the haemorrhage. The objective of the study was to determine the frequency of peripartum hysterectomy in placenta praevia.

Methods: The study was cross-sectional. It was conducted at the Department of Obstetrics and Gynaecology, Punjab Medical College and affiliated Hospital, Faisalabad. Study was carried out over a period of six months from October 2010 to March 2011. Total 130 cases of placenta praevia undergone caesarean section were included in this study. In cases of primary postpartum haemorrhage conservative management was done first in the form of intramuscular syntometrine (Oxytocin 5 IU/ergometrine 0.5 mg). Intravenous infusion syntocinon (40 IU in 500ml 0.9% saline over 4-6 hours).

Results: Mean age of the patients was found to be 30.9±6.7 years. Distribution of cases by gestational age shows, 52 (40.0%) patients had gestation of 28-36 weeks and 78 (60.0%) patients had gestation of 37-41. Mean gestational age was observed 37.5±3.4 weeks. Parity distribution was as follows: 76 (58.5%) patients had parity 0-3, 34 (26.1%) patients had parity 4-6 and 20 (15.4%) patients had parity > 6 with mean parity of 3.2±1.9. Conservative management was done in 129 patients (99.3%). Peripartum hysterectomy was found to be in 1 patient (0.7%).

Conclusions: Placental pathology is the leading cause of postpartum hemorrhage and the main indications of peripartum hysterectomy. Timely operation minimizes the morbidity and mortality.


Keywords


Placenta praevia, Peripartum hysterectomy, Caesarean section

Full Text:

PDF

References


Huque S, Roberts I, Fawole B. Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial. BMC Pregnancy Childbirth. 2018;18:186.

Mahmood S, Ayaz A. Obstetrical hysterectomy. J Surg Pak. 2005;10:20-3.

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(6):1281-94.

Oyelese Y, Smulian JC. Placenta previa, placenta accrete and vasa previa. Obstet Gynecol. 2006;107:927-41.

Malik AM, Siddique S, Shah IA, Placenta previa; a study to determine responsible factors. Professional Med J. 2007;407-10.

Campbell SM, Corcoran P, Manning E, Greene RA. Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland. Eur J Obstet Gynecol Reprod Biol. 2016;207:56-61.

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(6):1201-15.

WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, Hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389:2105-16.

Vandenberghe G, Guisset M, Janssens I. A nationwide population-based cohort study of peripartum hysterectomy and arterial embolisation in Belgium: results from the Belgian Obstetric Surveillance System. BMJ Open. 2017;7(11):e016208.

Clark SL, Koonings PP, Phelan JP. Placenta previa accrete and prior caesarean section. Obstet Gynecol. 1985;66:89-92.

Baker E. Caesarean section birth and hysterectomy. Clin Obstet Gynecol. 1994;37:806-15.

Kwame-Aryee RA, Kwakye AK, Seffahkwame-Aryee JD, Kwakye AK, Seffah JD. Peripartum hysterectomies at the korle-bu teaching hospital: a review of 182 consecutive cases. Ghana Med J. 2007;41:133-8.

Ouh YT, Lee KM, Ahn KH. Predicting peripartum blood transfusion: focusing on pre-pregnancy characteristics. BMC Pregnancy Childbirth. 2019;19(1):477.

Lier H, von Heymann C, Korte W, Schlembach D. Peripartum Haemorrhage: Haemostatic Aspects of the New German PPH Guideline. Transfus Med Hemother. 2018;45(2):127-35.

Singh A, Kishore R, Saxena SS. Ligating Internal Iliac Artery: Success beyond Hesitation. J Obstet Gynaecol India. 2016;66(Suppl 1):235-41.

Ono Y, Murayama Y, Era S. Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta. J Obstet Gynaecol Res. 2018;44(3):456-462.

WHO, UNICEF, UNFPA, United Nations, World Bank Group. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Divisions. Geneva: World Health Organization. 2015. Last accessed on

Shah N, Khan NH. Emergency obstetric hysterectomy: a review of 69 cases. Rawal Med J. 2009;34:47-9.