Introduction: Peripartum hysterectomy refers to hysterectomy that is performed for complications of vaginal delivery or during caesarean section. A common reason for peripartum hysterectomy is post partum haemorrhage (PPH). The aim of this study is to assess the incidence, indications and risk factors for emergency peripartum hysterectomy carried out at RIPAS hospital over an 11-year period. Materials and Methods: Patients who had undergone emergency peripartum hysterectomy over this 11-year (1999-2009) period were identified from the operation registry and the medical records were retrospectively reviewed. Data on maternal age, parity, gestational age, indication for peripartum hysterectomy, the type of operation performed and estimated blood loss were collected.Results: During the study period, there were a total of 59,974 deliveries (83.8% vaginal deliveries and 16.2% caesarean section deliveries) and 6,530 emergency obstetric surgeries. There were a total of 33 emergency peripartum hysterectomies performed accounting for 0.5% of all emergency obstetric surgeries performed. This translated to an overall incidence rate of 5.5 peripartum hysterectomies per 10,000 deliveries: 1.2 per 10,000 vaginal deliveries (n=6) and 27.9 per 10,000 caesarean sections deliveries (n=27). All peripartum hysterectomies were performed for massive PPH. The most common underlying pathology was placenta praevia (57.57%)followed by uterine atony. The risk for peripartum hysterectomy was high if placenta praevia was associated with previous scarred uterus as there is more chance of accreta. Conclusion: Our peripartum hysterectomy rate is comparable to what has been reported in the literature. The rate was higher for caesarean section deliveries. All peripartum hysterectomies were performed for PPH.
Hysterectomy ; Placenta Previa ; Postpartum Haemorrhage ; Peripartum Complications ; Uterine Atony

OBJECTIVETo analyze the clinical features and prognosis of patients with peripartum cardiomyopathy (PPCM).

METHODSThe clinical data of 28 PPCM patients with PPCM diagnosed in Peking Union Medical College Hospital from January 1983 to December 2014 were retrospectively analyzed and followed up for at least 6 months or to death or cardiac transplantation.

RESULTSAll patients were presented with heart failure. Mean baseline left ventricular ejection fraction (LVEF) was (36.2±11.8)%. After a median follow-up of 27 months, 16 of the 21 patients (76%) showed improvement in LVEF and 5 patients (24%) did not have improvement in their LVEF. Only 1 patient died. There were significant differences between improved and non-improved patients in baseline LVEF (P=0.007), baseline left ventricular end-diastolic dismension (LVEDD) (P=0.040), follow-up LVEF (P<0.001), and follow-up LVEDD (P<0.001). Cox regression analysis showed that higher LVEF (RR: 0.89, 95%CI: 0.83-0.96, P=0.002) and smaller LVEDD (RR: 0.90, 95%CI: 0.83-0.99, P=0.026) were predictors of improvement in LVEF.

CONCLUSIONSEarly diagnosis and regular treatment helps to improve the prognosis of PPCM. Patients with higher LVEF and smaller LVEDD appear to be the most likely to recover.

Cardiomyopathies ; Female ; Humans ; Peripartum Period ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Prognosis ; Regression Analysis ; Retrospective Studies ; Ventricular Function, Left

Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.
Anesthesia, Epidural/*methods ; Anesthesia, Spinal/*methods ; Cardiomyopathies/*complications ; Female ; Humans ; Peripartum Period ; Pre-Eclampsia/*surgery ; Pregnancy ; Sufentanil/*therapeutic use

Idiopathic peripartum cardiomyopathy is an uncommon malady disease. Making the diagnosis is often difficult and it is always necessary to exclude other prior heart disease and other causes of left ventricular dysfunction in pregnant women. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are further amplified when the common complications of pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy. This may be aggravated by making a late diagnosis and providing inappropriate treatment. We experienced a 38-year-primigravida who has diagnosed with idiopathic peripartum cardiomyopathy and underwent elective cesarean section with general anesthesia.
Anesthesia ; Anesthesia, General ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cesarean Section ; Delayed Diagnosis ; Female ; Heart Diseases ; Heart Failure ; Humans ; Hypertrophy ; Peripartum Period ; Pregnancy ; Pregnancy Complications ; Pregnant Women ; Ventricular Dysfunction, Left

INTRODUCTIONPeripartum cardiomyopathy (PPCM) is an uncommon form of congestive heart failure, affecting obstetric patients around the time of delivery. The epidemiology of PPCM is infrequently reported. This study was undertaken to define the prevalence, presentation and outcome of PPCM among women giving birth in a teaching hospital in Malaysia.

METHODSA retrospective case record analysis was conducted on all patients admitted and diagnosed with PPCM at the University Malaya Medical Centre, Kuala Lumpur, Malaysia, from 1 January 2000 to 31 December 2009. All deliveries were undertaken in the same hospital.

RESULTSA total of 12 patients were diagnosed with PPCM during the ten-year study period. The prevalence of PPCM was 2.48 in 100,000 (1 in 40,322) live births. Nine women were diagnosed with PPCM within five months of delivery. Three women had twin pregnancies. There was one death in the group (mortality rate 8.3%). The mean left ventricular ejection fraction at the time of diagnosis was 28.9% ± 8.5% (range 15%-40%). Following the index event, left ventricular function normalised in six of the nine patients (66.7%) who underwent subsequent echocardiography one year later. All patients were treated with standard heart failure therapy. Two patients with normalised left ventricular function had subsequent pregnancies - one pregnancy was terminated at seven weeks and the other patient delivered uneventfully at full term.

CONCLUSIONPPCM is uncommon. The outcome in our series was favourable, with 66.7% of patients with PPCM recovering their left ventricular function. The mortality rate was 8.3%.

Adult ; Asian Continental Ancestry Group ; Cardiology ; methods ; Cardiomyopathy, Dilated ; complications ; therapy ; Echocardiography ; methods ; Female ; Humans ; Malaysia ; Obstetrics ; methods ; Peripartum Period ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Prevalence ; Puerperal Disorders ; therapy ; Retrospective Studies ; Treatment Outcome ; Ventricular Dysfunction, Left ; therapy

Adult ; Cardiology ; methods ; Cardiomyopathy, Dilated ; diagnosis ; mortality ; Female ; Humans ; Obstetrics ; methods ; Peripartum Period ; Pregnancy ; Pregnancy Complications, Cardiovascular ; diagnosis ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Puerperal Disorders ; diagnosis ; mortality ; Risk Factors ; Ventricular Dysfunction, Left ; diagnosis ; mortality

By means of hospital-based data over 8 years we sought to evaluate the clinical indications and incidence of emergency peripartum hysterectomy by demographic characteristic and reproduction history. From the obstetric record of all deliveries at Chung Goo Hospital between Jan. 1, 1990, and Nov. 31, 1997, we identified all women undergoing emergency cesarean hysterectomy, calculated incidence rates, conducted statistical tests of linear trends and heterogenety, and observed the clinical indicatons preceding the onset of this procedure. There were 16731 deliveries during this period, Cesarean hysterectomy was performed in 24 of 5993 cesarean sections(0.40%) and in 10 of 10738 vaginal deleveries(0.09%), so more frequently after cesarean section than vaginal delivery. The age of patients varied from 22 to 40 years old. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(52.94%) followed by placental disorders(41.18%), uterine myoma with pregnancy(2.9%) and uterine rupture (2.9%). All patients who had hysterectomy received transfusion from 1 pint to 57 pints. The postoperative complications were bladder injury, febrile morbidity, disseminated intravascular coaguolopathy and wound disruption. There were three maternal deaths, the cause was disseminated intravascular coaguolopathy and amniotic embolism. The data identifiy uterine atony as the primary cause for gravid hysterctomy. The data also illustrated how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high.
Adult ; Cesarean Section ; Embolism ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period* ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Reproduction ; Urinary Bladder ; Uterine Inertia ; Uterine Rupture ; Wounds and Injuries

OBJECTIVE: This article was to review 10 years experience of cesarean hysterectomy at our hospital. To review risk factors, management & outcome of emergency peripartum hysterectomy performed in last 10 years at our hospital. MATERIAL & METHODS: The outcome of 33 cases of cesarean hysterectomy performed at St. Benedict hospital during 10 years from Jan. 1990 to Dec. 1999 was discussed & evaluated. RESULTS: During this time, there was 16014 deliveries, of which 5640 were cesarean section and 25 were cesarean hysterectomies, an incidence of 0.44%, and of which 10374 were vaginal deliveries 8 were. Cesarian hysterectomies are incidence of 0.08%. The age of patients varies from 18 to 42. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was placental abnormal presentation [placenta accreta (30.3%), placenta previa (27.2%)], uterine atony (33.3%), uterine myoma with pregnancy (6.0%) and Uterine ruture (3.0%). The complication were febrile morbidity, disseminated intravascular coagulopathy and urinary tract injury. There was one maternal death. CONCLUSION: Postoperative complication still remain the causes of maternal morbidity. There careful prenatal care momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjunction with maternal life saving. Cesarean delivery, prior cesarean delivery placenta accreta and uterine atony were identified as risk factors for emergency peripartum hysterectomy and abnormal presentation was the primary cause of cesarean hysterectomy. Still, cesarean hysterectomy remains a potentially life saving procedure with which every obstetrician must be familiar.
Blood Transfusion ; Cesarean Section ; Emergencies ; Female ; Humans ; Hysterectomy* ; Incidence ; Leiomyoma ; Maternal Death ; Parity ; Peripartum Period ; Placenta Accreta ; Placenta Previa ; Postoperative Complications ; Pregnancy ; Prenatal Care ; Risk Factors ; Urinary Tract ; Uterine Inertia

OBJECTIVE: To investigate the clinical characteristics and associated risk factors for emergency peripartum hysterectomy classified by the amounts of blood loss. MATERIAL AND METHODS: We reviewed the medical records of 159 cases of peripartum hysterectomy among 46,666 deliveries, from Jan. 1995 to Dec. 2005 at the Dept. of Ob. & Gy. of Graduate School of Medicine, Gachon University of Medicine and Science. We divided the 159 cases into three groups based on the amounts of blood loss, which were group A as less than 2,000 mL of blood loss, group B as 2,000 to 4,000 mL of blood loss, and group C as more than 4,000 mL. The incidence, the type of delivery, the amounts of transfusion, the operative indication and the complications of peripartum hysterectomy were evaluated. RESULTS: The incidence of peripartum hysterectomy was 0.34% (159/46,666) and 0.47% in cases of cesarean section and 0.19% in vaginal delivery, respectively. There was no meaningful correlation between maternal age, parity, gestational age, hospital stay and amount of blood loss. The increments of blood loss correlated to the frequency of peripartum hysterectomy after cesarean section (p<0.05). The most common operative indication in group A was uterine atony (47.19%), and those in group B and C were adherent placentation (48.08%, 50.00%). Intraoperative and postoperative complications according to excessive bleeding were increased, and DIC, pulmonary infection, urethral and bladder injury were observed more frequently in group C than in group A. CONCLUSION: The emergency peripartum hysterectomy was related to adherent placentation and was accompanied with increased blood loss.
Cesarean Section ; Dacarbazine ; Emergencies ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Length of Stay ; Maternal Age ; Medical Records ; Parity ; Peripartum Period ; Placentation ; Postoperative Complications ; Pregnancy ; Risk Factors ; Urinary Bladder ; Uterine Inertia