Peripartum Hysterectomy: Is There Any Difference Between Emergency and Planned Surgeries?

Oge, Tufan; Tokgoz, Vehbi Yavuz; Cakmak, Yusuf; Velipasaoglu, Melih

doi:10.1055/s-0041-1736303

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 44 (01) • Jan 2022 • https://doi.org/10.1055/s-0041-1736303 copy

Peripartum Hysterectomy: Is There Any Difference Between Emergency and Planned Surgeries?

Histerectomia periparto: Existe alguma diferença entre as cirurgias de emergência e planejada?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the outcomes of emergency and planned peripartum hysterectomies.

Methods

The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies.

Results

A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p=0.014), and higher postoperative hemoglobin levels (9.9±1.3 versus 8.3±1.3; p<0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases.

Conclusion

Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.

Keywords:
abnormal placentation; emergency; peripartum hysterectomy; planned; uterine atony

	Emergency hysterectomy(n = 35)	Planned hysterectomy(n = 31)	p-value
Age (years)	31.9 ± 6.5	30.5 ± 4.1	0.18
Gravidity	3.9 ± 2.6	4.1 ± 2.1	0.36
Parity	2.9 ± 2.6	2.6 ± 1.8	0.94
Mean gestational age (weeks)	36.3 ± 4.9	35.2 ± 1.8	0.002
Gestational age (weeks) – n(%)
< 28	2(6.3)	0(0)	0.169
28–34	5(15.6)	3(9.7)
> 34	25(78.1)	28(90.3)
Mode of delivery – n(%)
Vaginal delivery	14(40)	0(0)	0.001
Cesarean delivery	21(60)	31(100)	0.001
Previous cesarean section – n(%)	7(20.0)	26(83.9)	0.001
Preoperative hemoglobin (g/dL)	10.1 ± 2.2	10.8 ± 1.2	0.10
Preoperative hematocrit (%)	32.1 ± 5.8	32.4 ± 3.0	0.84
Preoperative platelet count (x10⁹/L)	222.0 ± 73.6	203.2 ± 58.5	0.30

	Emergency hysterectomy(n = 35)	Planned hysterectomy(n = 31)	Overall(n = 66)
Uterine atony – n(%)	20(57.1)	0(0)	20(30.3)
Uterine rupture – n(%)	9(25.7)	0(0)	9(13.6)
Placenta previa – n(%)	1(2.9)	2(6.5)	3(4.5)
Placenta accreta – n(%)	5(14.3)	21(67.7)	26(39.4)
Placenta percreta – n(%)	0(0)	8(25.8)	8(12.1)

	Emergency hysterectomy(n = 35)	Plannedhysterectomy(n = 31)	p-value
Red blood cell transfusion – n(%)	35(100)	26(83.9)	0.014
Number of red blood cell transfusions(units)	6.0 ± 5.0	3.9 ± 3.7	0.06
Fresh frozen plasma transfusion – n(%)	34(97.1)	23(74.2)	0.007
Number of fresh frozen plasma transfusions(units)	5.9 ± 5.4	2.5 ± 2.1	0.001
Postoperative hemoglobin (g/dL)	8.3 ± 1.3	9.9 ± 1.3	< 0.001
Postoperative platelet count (x10⁹/L)	119.0 ± 55.8	158.3 ± 44.3	0.12
Difference between pre- and postoperative hemoglobin (g/dL)	1.7 ± 1.5	0.9 ± 0.7	0.03
Difference between pre- and postoperative hemoglobin (after transfusions; g/dL)	7.8 ± 5.9	4.8 ± 4.6	0.02
Vessel injury – n(%)	0(0)	0(0)	1
Nerve injury – n(%)	1(3)	0(0)	0.39
Retroperitoneal hematoma – n(%)	1(3)	0(0)	0.40
Bladder injury – n(%)	4(11)	14(45)	0.38
Ureteral injury – n(%)	0(0)	1(3)	0.39
Duration of hospital stay (days)	8.2 ± 5.9	6.9 ± 3.5	0.57

	Emergency hysterectomy(n = 35)	Planned hysterectomy(n = 31)	p-value
Birth weight (g)	3041 ± 1186	2564 ± 491	0.003
Apgar scores
1 minute	4.9 ± 3.4	7.5 ± 1.9	0.001
5 minutes	6.5 ± 3.9	9.2 ± 1.1	0.006

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[1] Address for correspondence
Vehbi Yavuz Tokgoz, Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey (e-mail: mdtokgoz@hotmail.com).