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A review of blood transfusion associted with peripartum hysterectomy. A 10-year review
Abstract Number: 35
Abstract Type: Original Research
Introduction: Emergency Peripartum Hysterectomy (EPH) is a rare but potentially lifesaving procedure in the setting of massive obstetric haemorrhage (1). Although recent advances have benn made in the development of medical and surgical conservative treatment of massive haemorrhage, EPH remains a lifesaving procedure in the management of massive haemorrhage unresponsive to these measures.
The aim of the review was to evaluate the risk factors and blood transfusion associated with EPH.
Methods: We conducted a retrospective review of all patients who had EPH in our hospital from 2000-2009. Patients were identified from the departmental pateint database and the hospital annual clinical report. The case notes were retrieved and reviewed. Demographic data and clinical variables were obtained and analysed. Patients who had planned/anticipated and those who had unanticipated caesarean delivery/EPH were reviewed. The definition of "planned"/anticipated procedure was that the decision to perform the procedure was made with the patient prior to presentation based on known diagnosis of placenta accreta/increta/percreta.
Results: During the 10-year review period there were a total of 73,329 deliveries. Thirty-one EPH were performed giving an incidence of 0.42per 1000 births. Of these 12/31(39%) and 19/31 (61%) were planned/anticipated and unanticipated respectively. Previous caesarean delivery 11(92%) vs 6 (32%) p =0.002, multiparity 12 (100%) vs 15 (79%) p =0.04 and placenta accreta 9 (75%) vs 12 (63%) were recorded in planned/anticipated compared with the unanticipated patients respectively. The maternal morbidities and outcomes are shown in table.
There was one maternal death in the unanticipated group due to E.Coli septicaemia. The caesarean rate during this period was 26.7%.
Conclusion: Previous caesarean delivery, multiparity and placenta accreta significantly increased the risk for EPH. Massive blood transfusion, reoperation and ICU admissions were more likely where EPH was unanticipated.
Reference: Flood KM, Said S, Geary M, et al. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol2009;200:632.e1-632.e6