RETROSPECTIVE 6 YEARS STUDY OF MATERNAL OUTCOME AFTER CAESAREAN HYSTERECTOMY IN SULAIMANI MATERNITY TEACHING HOSPITAL

Chro Najmaddin Fattah a and Shanyar Mohamed b


a Department of Gynecology and Obstetrics, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
b Kurdistan Board Medical Studies Candidate.


Submitted: 1/17/2018; Accepted: 21/10/2018; Published 21/6/2019

ABSTRACT


Background 

Caesarean hysterectomy is one of the surgical procedures that performed as a last choice for saving mothers life challenging all obstetricians about the exact management between saving life or saving the fertility with the available resources. 


Objectives 

This study was conducted to determine incidence, associated factors and maternal morbidity and mortality after cesarean hysterectomy.

Patients and Methods

It is a descriptive retrospective study conducted over 6 years from 2012 to 2017 included all caesarean (peripartum) hysterectomies performed in Sulaimani maternity teaching hospital beyond 24 week gestation. File records was used to determine the data regarding the research. We used “IBM SPSS Statistics version 20” for the analysis of the data.


Results

The prevalence of cesarean hysterectomy was 0.56/1000 total deliveries. The ages were between 35-40 years, risk factors of last pregnancy were obesity, grand multiparity, and previous C\S were found in 55%, 65%, and 65% respectively. For antepartum and intrapartum risk factor antepartum hemorrhage and postpartum hemorrhage represented 20% and 30% respectively. Most of their pervious pregnancies delivered by (C/S) and 20% had history of 3 previous C/S, and 25% their pregnancy was complicated by gestational diabetes mellitus. Regarding intraoperative management blood product, B- Lynch suture, internal iliac artery ligation, intrauterine balloon, and recombinant factor 7 used in almost all cases. In follow up cases for 1 year chronic pelvic pain was most frequent complaint in 20% and ovarian cyst was also found in about 25%. 


Conclusion

Prevalence of cesarean hysterectomy incidence was 0.56/1000 total deliveries. The significant risk factors were obesity, grand multiparity, and history of previous C\S sections. Regarding maternal age is not far from the international age related to cesarean hysterectomy.


KEYWORDS

Caesarean hysterectomy, Postpartum hemorrhage, Antepartum hemorrhage, Placenta previa, lacenta accreta/increta, multiparity.

References 

1- Confidential Enquiry into Maternal and Child Health: why mothers die 2000-2002, London (UK): Royal College of Obstetricians and Gynecologist; 2004; 6: 80-93. 
2- Zorlu CG, Turan C, Isik AZ, Danisman N, Mungan T, Gokmen O. Emergency hysterectomy in modern obstetric practice . Acta Obstet Gyneacol Scand 1998;77:186-90.
3- Kastner ES, Fiqueroa R, Garry D, Maulik D, emergency peripartum hysterectomy: experience at a community teaching hospital. Obstet Gyneacol. 2002; 99:971-5
4- B-Lynch C, Coker A, Lawal AH, Abu J, Cowen M. The B-Lynch surgical technique for the control of massive postpartum hemorrhage an alternative to hysterectomy? Five cases reported. BJOG. 1997; 104:372-5.
5- AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrollable postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol. 1994; 171:694-700.
6- Kwee A, Michiel L, Visser GHA, Bruinse HW. Emergency peripartum hysterectomy: A prospective study in the Netherlands. European journal of obstetrics and gynecology. 2006; 124:187-192 
7- Kacmar J, Bhimani L, Boyd M, Shah-Hosseini R, Peipert JF. Route of delivery as a risk factor for emergency peripartum hysterectomy: a case control study. Obstet Gynecol. 2003; 102:141-5 

8- Jagielska I, Kazdepka-Ziemińska A, Tyloch M, Papierski M, Zołniezewicz K, Grabiec M, et al. [Clinical study of perinatal hysterectomy between 2000-2011 in the clinic of obstetrics, gynecological diseases and oncological gynecology in Bydgoszcz]. Ginekol Pol. 2014; 85 (3):192-6.
9- Amsalem H, Kingdom JC, Farine D, Allen L, Yinon Y, D'Souza DL, et al. Planned caesarean hysterectomy versus "conserving" caesarean section in patients with placenta accreta .J Obstet Gynaecol Can. 2011; 33 (10):1005-10.
 10- Polat Dursun. Use of bulldog vascular clamps to reduce intraoperative bleeding during cesarean hysterectomy for placenta percreta. Int J Gynaecol Obstet. 2017; 21.
11- Knight M. National perinatal epidemiology unit. Peripartum hysterectomy in UK: management and outcome of the associated hemorrhage. International J of obstetrics and gynecology. 2007; 114:1380-1387.
12- Sturdee DW, Rushton DI. Cesarean and postpartum hysterectomy. J Obstet Gynaecol. 1983; 93: 270-274. 
13- WHO statement of cesarean sections rates, HRP.2015:1;1-3. 
14- Andre K, Irene H, Rahel T, Corinne U, Dorothy H, Brigitte L, et al. Maternal request: a reason for rising rates of cesarean sections? Archives of gynecology and obstetrics. 2012:286 (1):93-98
15- Masafumi K, Shingo U. Cesarean hysterectomy for Abnormal Placentation Using Balloon Occlusion of the Common Iliac Artery: Case Series. Woman health open J. 2017; 3(1): 15-20. 
16- Sahin Z, Yusif U, Yaprak E, Guler S, Mansur K. Peripartum hysterectomy in teaching hospital in the eastern region of Turkey. European journal of obstetrics and gynecology. 2005; 120:57-62.
17- Ding DC, S. Hsu, Chu TW, Chu TY. Emergency peripartum hysterectomy in a teaching hospital in eastern Taiwan. The journal of obstetrics and gynecology. 2009:26; 635-638
18- Machado LSM. Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome . North American journal of medical science. 2011; 3(8): 358-361
19- Tapisiz O, Altinbas S, Yarci B, Cenksoy P, Kaya A, Dede S, et al. . Emergency peripartum hysterectomy in a tertiary hospital in Ankara, Turkey: a 5 years review. Arch gynecology obstetrics. 2012; 286 (5):1131-1134 
20- Gurtani FM, Fedaei B, Akbari M. Emergency peripartum hysterectomy in Asfahan; maternal mortality and morbidity rates among the women who underwent peripartum hysterectomy. Advanced biochemical research. 2013; 2: 20-32.
21- Wane R, Abu-Hudra N, Al-Tahir S. Emergency peripartum hysterectomy: A 13 years review at a tertiary center in Kuwait. J obstetrics gynecology India. 2014; 64 (6): 403-408
22- Muna A, Mahera A, Nawal M, Mushtaq O, Fatima C, Shazia M , et al. Emergency peripartum hysterectomy in the Dubai health system: A 15 years experience. Turk J Obstet Gynecol. 2018; 15(1): 1-7.
23- Yamani ZT. Indication of emergency peripartum hysterectomy; review 17 cases. Arch gynecology obstetrics. 2003; 268(3): 131-135
24- Glaze S, Ekwalanga P, Roberts G, Lange I, Birch C, Posengarten A, et al. Peripartum hysterectomy 1999-2006. Obstetrics and gynecology. 2008; 111(3):732-738 
25- Mohaparta I, Ranjan S, Pruthwiraj. Emergency peripartum hysterectomy: A 3 year experience at tertiary care center. Perspective in medical research. 2016: 4(1): 42-44.
26- Jin Rong, Guo Yuna Chen Yan. Risk factor associated with. Emergency peripartum hysterectomy. China Med L 2014; 127 (5):900-904. 
27- Shamsa A, Harris A, Anpalagan A. Peripartum hysterectomy in a tertiary hospital in western Sydney. The journal of obstetrics and gynecology. 2015; 35: 350-353.
28- Begum M, Alsafi F, EIFarra J, Tamim H, Lie Tin. Emergency peripartum hysterectomy in in a tertiary hospital in Saudi Arabia. The Journal of Obstetrics and gynecology of India. 2014; 64(5): 321-327.
29- Clark SL, Yeh SY, Phelan JP, Bruce S, Paul RH. Emergency hysterectomy for obstetric hemorrhage. Obstetrics and gynecology.1984:64(3):376-380.
30- Bai SW, Lee HJ, Cho JS, Park KH. Peripartum hysterectomy and associated factors. Journal of reproductive medicine. 2003:48; 148-152
31- Soz M, Atia S. Emergency cesarean hysterectomy Incidence, Indication and maternal outcome Sulaimani and Erbil maternity teaching hospital. 2013;1:12-13.
32- Dittakarn B, Pattarawalai T, Prasert S, Ratre S. Adverse pregnancy outcome of in gestational diabetes mellitus. J Med Assoc Thai. 2006; 89:23-28
33- Molly W, Staff W. C-section now, hysterectomy Complication later? MedPage Today General OB/GYN.2017:8;45-50 


Creative Commons License © The Authors, published by University of Sulaimani, College of Medicine