A district-wide population-based descriptive study of emergency peripartum hysterectomy in a middle-income country

Anke Heitkamp, Jorrit Seinstra, Thomas van den Akker, Linda Vollmer, Stefan Gebhardt, Jos van Roosmalen, Johanna I. de Vries, Gerhard Theron

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective: To determine incidence, risk indicators, and outcomes of emergency peripartum hysterectomy (EPH) in Metro East, Cape Town, South Africa. Methods: A population-based district-wide prospective descriptive study of EPH in public hospitals from November 2014 to November 2015. Women were enrolled by using the WHO maternal near miss tool and followed until discharge. EPH was defined as hemorrhage or infection leading to hysterectomy during pregnancy or within 42 days of delivery. Results: Fifty-nine women experienced EPH with an overall incidence of 14.3 per 10 000 women: 32 procedures were for postpartum hemorrhage, 27 for puerperal sepsis. Two women died: one from sepsis; one from hemorrhage. Overall, 51 (86%) women delivered by cesarean, and 23/51 (45%) by repeat cesarean. As compared with hemorrhage, EPH for sepsis involved older women (mean age, 31.5 vs 24.4 years) and those with higher gravidity (median, 3 vs 1), and was associated with longer hospital admission (median, 11.5 vs 4 days), with occurrence later postpartum (median, 8 vs 0 days), and more frequently with complications. Conclusions: The incidence of EPH for sepsis was higher than previously reported. Repeat cesarean was strongly associated with EPH. Clinical characteristics of sepsis-related EPH compared unfavorably with those of hemorrhage-related EPH.

Original languageEnglish
JournalInternational Journal of Gynecology and Obstetrics
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Peripartum Period
Hysterectomy
Emergencies
Population
Sepsis
Hemorrhage
Incidence
Gravidity
Postpartum Hemorrhage
Public Hospitals
South Africa
Postpartum Period
Mothers
Prospective Studies

Keywords

  • Emergency peripartum hysterectomy
  • High-risk pregnancy
  • Maternal mortality
  • Maternal near miss
  • Maternal sepsis
  • Obstetric surgery
  • Postpartum hemorrhage
  • Quality of obstetric care

Cite this

Heitkamp, Anke ; Seinstra, Jorrit ; van den Akker, Thomas ; Vollmer, Linda ; Gebhardt, Stefan ; van Roosmalen, Jos ; de Vries, Johanna I. ; Theron, Gerhard. / A district-wide population-based descriptive study of emergency peripartum hysterectomy in a middle-income country. In: International Journal of Gynecology and Obstetrics. 2019.
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abstract = "Objective: To determine incidence, risk indicators, and outcomes of emergency peripartum hysterectomy (EPH) in Metro East, Cape Town, South Africa. Methods: A population-based district-wide prospective descriptive study of EPH in public hospitals from November 2014 to November 2015. Women were enrolled by using the WHO maternal near miss tool and followed until discharge. EPH was defined as hemorrhage or infection leading to hysterectomy during pregnancy or within 42 days of delivery. Results: Fifty-nine women experienced EPH with an overall incidence of 14.3 per 10 000 women: 32 procedures were for postpartum hemorrhage, 27 for puerperal sepsis. Two women died: one from sepsis; one from hemorrhage. Overall, 51 (86{\%}) women delivered by cesarean, and 23/51 (45{\%}) by repeat cesarean. As compared with hemorrhage, EPH for sepsis involved older women (mean age, 31.5 vs 24.4 years) and those with higher gravidity (median, 3 vs 1), and was associated with longer hospital admission (median, 11.5 vs 4 days), with occurrence later postpartum (median, 8 vs 0 days), and more frequently with complications. Conclusions: The incidence of EPH for sepsis was higher than previously reported. Repeat cesarean was strongly associated with EPH. Clinical characteristics of sepsis-related EPH compared unfavorably with those of hemorrhage-related EPH.",
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A district-wide population-based descriptive study of emergency peripartum hysterectomy in a middle-income country. / Heitkamp, Anke; Seinstra, Jorrit; van den Akker, Thomas; Vollmer, Linda; Gebhardt, Stefan; van Roosmalen, Jos; de Vries, Johanna I.; Theron, Gerhard.

In: International Journal of Gynecology and Obstetrics, 01.01.2019.

Research output: Contribution to JournalArticleAcademicpeer-review

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AU - Gebhardt, Stefan

AU - van Roosmalen, Jos

AU - de Vries, Johanna I.

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AB - Objective: To determine incidence, risk indicators, and outcomes of emergency peripartum hysterectomy (EPH) in Metro East, Cape Town, South Africa. Methods: A population-based district-wide prospective descriptive study of EPH in public hospitals from November 2014 to November 2015. Women were enrolled by using the WHO maternal near miss tool and followed until discharge. EPH was defined as hemorrhage or infection leading to hysterectomy during pregnancy or within 42 days of delivery. Results: Fifty-nine women experienced EPH with an overall incidence of 14.3 per 10 000 women: 32 procedures were for postpartum hemorrhage, 27 for puerperal sepsis. Two women died: one from sepsis; one from hemorrhage. Overall, 51 (86%) women delivered by cesarean, and 23/51 (45%) by repeat cesarean. As compared with hemorrhage, EPH for sepsis involved older women (mean age, 31.5 vs 24.4 years) and those with higher gravidity (median, 3 vs 1), and was associated with longer hospital admission (median, 11.5 vs 4 days), with occurrence later postpartum (median, 8 vs 0 days), and more frequently with complications. Conclusions: The incidence of EPH for sepsis was higher than previously reported. Repeat cesarean was strongly associated with EPH. Clinical characteristics of sepsis-related EPH compared unfavorably with those of hemorrhage-related EPH.

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