- Email: [email protected]
Ruptured uterus — A study of 32 cases
TUESDAY.
SEPTEMBER
5
FC2.37.03 RISK FACTORS FOR EMERGENCY PERIPARTLJM HYSTERECTOMYAN EXPERIENCE OF A DEVELOPING COUNTRY. S. Roof N. Nasrin, .I. Begum, R. Begum, A.Begum, Dept. OB/GYN, Dhaka Medical College Hospital, Dhaka, Bangladesh. S. Nahar, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh Objective: To evaluate the prevalence, clinical indications, risk factors and outcome of emergency peripartum hysterectomy in women delivered at Dhaka Medical College and Hospital in Bangladesh. Study Methods: This is a prospective cross sectional study of all cases of emergency peripartum hysterectomy performed in the year 1999 from l* Janmary to 31* December. Statistical analysis were carried out with mean f SD, proportion, relative risks for hysterectomy with 95% confidence intervals (CI) and Chi square test. Results: During the study period there were 62 cases of emergency peripartum hysterectomy (incidence of 6.63/1000 deliveries), of which 20 cases were caesarean hysterectomy. Mean age of patients was 30.28 f 5.93 years, median parity was 2 (range was 0 to 7) and the mean gestational age was 39.09 f 1.60 weeks. Indications for hysterectomy were primarily rupture uterus due to obstructed labour (66.13%, p=O.OOO), postpartum haemorrhage (17.74%, p=O.OOO), prior caesarean section with scar rupture (6.4.5%), uterine infection (6.45%) and placenta praevia (3.23%). The relative risk of emergency hysterectomy was 68.72 (95% CI 49.13-96.11) for rupture uterus, 10.12 (95% CI 5.43-18.85) for postpartum haemorrhage, 0.65 (95%CI 0.24-1.79) for prior caesarean delivery, 1.11 (95% CI 0.41-3.04) f or uterine infection and 1.02 (95% CI 0.25-4.13) for placenta praevia. Maternal death was 17.74% (n=ll) and perinatal death was 79.03% (n=49). Conclusions: Rupture uterus still remains an important identified risk factor for emergency peripartum hysterectomy for developing countries. Identification of patients at risk and anticipation of procedure and complications were important because peripartum hysterectomy is usually associated with considerable perioperative morbidity and mortality though it is a necessary life saving procedure for obstetric practice.
FC2.37.04 RUPTURED UTERUS -A STUDY OF 32 CASES A. Beeum, Dept. OB/GYN, Dhaka Medical College Hospital, Dhaka, Bangladesh. Objectives: The aim of this study was to determine the number of ruptures uterus cases admitted out of total (3342) obstetrical patients in a Rangpur Medical College Hospital between January 1992 to June 1993 and to see the incidence of maternal and perinatal mortality and morbidity due to this factor. Study Methods: This study encountered 32 ruptured uterus cases out of 3342 obstetrical patients, admitted for delivery in obstetric department of Rangpur Medical College Hospital between January 1992 to June 1993. Results: Out of 32 cases of ruptured uterus patients, 6 cases were over 35 years old, 11 cases were grand multiparous patients. Ruptured uterus was mostly due to cephalopalvic disproportion. Sub total hysterectomy was done in majority of cases (22). There were no maternal deaths in this study but morbidity was very high and only one fetus survived out of 32 cases. Conclusion: As ruptured uterus is one of the important causes of maternal death (6.5%) and fetal death in developing countries like ours, midwife education, regular antenatal check up, proper selection of the patients for hospital delivery, adequate intranatal care and early referral for emergency obstetric care are the important factors in prevention of this obstetric hazard. Though it is one of the important causes of maternal death in developing countries, it is preventable., Timely diagnosis, proper referral and appropriate management of the cases can reduce the maternal death substantially but may not reduce the fetal death to the same extent.
91
FC2.37.05 EMERGENCY PERIPARTLJM HYSTERECTOMY: A RETROSPECTIVE REVIEW A.M.B. Al-Takroni, K.B.L. Mendis, Dept. OB/GYN, Al Yamamah Hospital, Riyadh, Saudi Arabia. Objective: To review 10 years’ experience of emergency peripartum hysterectomy. Study Method: Retrospective review of departmental statistics and records of patients who underwent peripartum hysterectomy at Al Yamamah Hospital from August 1, 1989 to July 31,1999. Results: During this period there were 139022 births (118469 vaginal and 20553 cesarean) and 44 cases of either cesarean (n=26) or immediate postpartum (n=lE) hysterectomy, with 25 being total and 19 subtotal. The incidence of peripartum hysterectomy was 0.032/100 births. The mean (range) parity and gestational age were 4.6 (O-13) and 37.8 weeks (26-42) respectively. 26 cases underwent cesarean section for placenta previa and all required hysterectomy to overcome uncontrollable bleeding. 23 of these cases had placenta accreta and prior cesarean scars. Indication for postpartum hysterectomy in 13 patients was uterine atony and in 5 rupture of unscarred uterus. 3/5 uteri ruptured during postaglandin induced labor. In 39 cases (89%) estimated blood loss was at least 2000 cc (range lOOO20,000). All patients required blood transfusions. There was no significant difference in blood loss with respect to type or indication for hysterectomy. Maternal complications included 11 cases of coagulopathy, 6 cases of bladder injury, 12 wound complications but no maternal mortality. There were 2 intrapartum fetal deaths and 2 neonatal deaths due to prematurity. Mean post operative hospital stay for mothers was 9 days. Conclusions: Blood loss of 2000 cc or more, placenta previa and previous cesarean section were identified risk factors leading to hysterectomy. For 23/44 (52%) cases, all three factors were identified.
FC2.37.06 SUBTOTAL HYSTERECTOMY LEADS TO IMPROVED SURVIVAL IN PATIENTS IN EXTREMIS WITH UTERINE RUPl?URE Raikumari Narone, MD, Jogendranath Narone, MD, Patna Medical College and Hospital, Patna, Bihar, India. Uterine rupture in a patient in extremis leads to significant maternal mortality. The aim of this paper is to evaluate subtotal hysterectomy (STH) vs. uterine repair (UR) for patients in extremis who present with uterine rupture. Between January 1993 and December 1998,39,667 hospital deliveries were carried out at an academic medical center in Bihar, India. Three hundred sixty seven patients presented with uterine rupture (incidence of uterine rupture was 1 in 108 deliveries) of which 96 patients presented in extremis, >20 hours delay in diagnosis, and an irregularly torn uterus found at operation. Charts were retrospectively reviewed to compare patient populations undergoing STH vs. UR and their outcomes. Results were analyzed using Fisher’s exact test. Sixty-one patients underwent subtotal hysterectomy (STH) while 35 underwent uterine repair (UR). There was no significant difference in the two groups with respect to patient age, parity, cause of rupture, and clinical condition at time of evaluation (p>O.2). The operative time for STH was significantly less than UR, 35 min. vs. 57 min (p
FC2.37.07 ISOLATED RUPl?URE OF THE URINARY BLADDER DURING LABOUR: A 12.YEAR REVIEW S.M.Padhve. Dept. OB/GYN, Maternity Hospital, Kathmandu, Nepal. Objective: The aim of the study was to find the incidence of the isolated rupture of the bladder during labor and review some of the literature. Study Methods: The case notes provisionally diagnosed as “Rupture of the Uterus” were studied. This is a retrospective study. One hundred and twenty case notes labeled as “Rupture of the Uterus” - (provisionally
SEPTEMBER
5
FC2.37.03 RISK FACTORS FOR EMERGENCY PERIPARTLJM HYSTERECTOMYAN EXPERIENCE OF A DEVELOPING COUNTRY. S. Roof N. Nasrin, .I. Begum, R. Begum, A.Begum, Dept. OB/GYN, Dhaka Medical College Hospital, Dhaka, Bangladesh. S. Nahar, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh Objective: To evaluate the prevalence, clinical indications, risk factors and outcome of emergency peripartum hysterectomy in women delivered at Dhaka Medical College and Hospital in Bangladesh. Study Methods: This is a prospective cross sectional study of all cases of emergency peripartum hysterectomy performed in the year 1999 from l* Janmary to 31* December. Statistical analysis were carried out with mean f SD, proportion, relative risks for hysterectomy with 95% confidence intervals (CI) and Chi square test. Results: During the study period there were 62 cases of emergency peripartum hysterectomy (incidence of 6.63/1000 deliveries), of which 20 cases were caesarean hysterectomy. Mean age of patients was 30.28 f 5.93 years, median parity was 2 (range was 0 to 7) and the mean gestational age was 39.09 f 1.60 weeks. Indications for hysterectomy were primarily rupture uterus due to obstructed labour (66.13%, p=O.OOO), postpartum haemorrhage (17.74%, p=O.OOO), prior caesarean section with scar rupture (6.4.5%), uterine infection (6.45%) and placenta praevia (3.23%). The relative risk of emergency hysterectomy was 68.72 (95% CI 49.13-96.11) for rupture uterus, 10.12 (95% CI 5.43-18.85) for postpartum haemorrhage, 0.65 (95%CI 0.24-1.79) for prior caesarean delivery, 1.11 (95% CI 0.41-3.04) f or uterine infection and 1.02 (95% CI 0.25-4.13) for placenta praevia. Maternal death was 17.74% (n=ll) and perinatal death was 79.03% (n=49). Conclusions: Rupture uterus still remains an important identified risk factor for emergency peripartum hysterectomy for developing countries. Identification of patients at risk and anticipation of procedure and complications were important because peripartum hysterectomy is usually associated with considerable perioperative morbidity and mortality though it is a necessary life saving procedure for obstetric practice.
FC2.37.04 RUPTURED UTERUS -A STUDY OF 32 CASES A. Beeum, Dept. OB/GYN, Dhaka Medical College Hospital, Dhaka, Bangladesh. Objectives: The aim of this study was to determine the number of ruptures uterus cases admitted out of total (3342) obstetrical patients in a Rangpur Medical College Hospital between January 1992 to June 1993 and to see the incidence of maternal and perinatal mortality and morbidity due to this factor. Study Methods: This study encountered 32 ruptured uterus cases out of 3342 obstetrical patients, admitted for delivery in obstetric department of Rangpur Medical College Hospital between January 1992 to June 1993. Results: Out of 32 cases of ruptured uterus patients, 6 cases were over 35 years old, 11 cases were grand multiparous patients. Ruptured uterus was mostly due to cephalopalvic disproportion. Sub total hysterectomy was done in majority of cases (22). There were no maternal deaths in this study but morbidity was very high and only one fetus survived out of 32 cases. Conclusion: As ruptured uterus is one of the important causes of maternal death (6.5%) and fetal death in developing countries like ours, midwife education, regular antenatal check up, proper selection of the patients for hospital delivery, adequate intranatal care and early referral for emergency obstetric care are the important factors in prevention of this obstetric hazard. Though it is one of the important causes of maternal death in developing countries, it is preventable., Timely diagnosis, proper referral and appropriate management of the cases can reduce the maternal death substantially but may not reduce the fetal death to the same extent.
91
FC2.37.05 EMERGENCY PERIPARTLJM HYSTERECTOMY: A RETROSPECTIVE REVIEW A.M.B. Al-Takroni, K.B.L. Mendis, Dept. OB/GYN, Al Yamamah Hospital, Riyadh, Saudi Arabia. Objective: To review 10 years’ experience of emergency peripartum hysterectomy. Study Method: Retrospective review of departmental statistics and records of patients who underwent peripartum hysterectomy at Al Yamamah Hospital from August 1, 1989 to July 31,1999. Results: During this period there were 139022 births (118469 vaginal and 20553 cesarean) and 44 cases of either cesarean (n=26) or immediate postpartum (n=lE) hysterectomy, with 25 being total and 19 subtotal. The incidence of peripartum hysterectomy was 0.032/100 births. The mean (range) parity and gestational age were 4.6 (O-13) and 37.8 weeks (26-42) respectively. 26 cases underwent cesarean section for placenta previa and all required hysterectomy to overcome uncontrollable bleeding. 23 of these cases had placenta accreta and prior cesarean scars. Indication for postpartum hysterectomy in 13 patients was uterine atony and in 5 rupture of unscarred uterus. 3/5 uteri ruptured during postaglandin induced labor. In 39 cases (89%) estimated blood loss was at least 2000 cc (range lOOO20,000). All patients required blood transfusions. There was no significant difference in blood loss with respect to type or indication for hysterectomy. Maternal complications included 11 cases of coagulopathy, 6 cases of bladder injury, 12 wound complications but no maternal mortality. There were 2 intrapartum fetal deaths and 2 neonatal deaths due to prematurity. Mean post operative hospital stay for mothers was 9 days. Conclusions: Blood loss of 2000 cc or more, placenta previa and previous cesarean section were identified risk factors leading to hysterectomy. For 23/44 (52%) cases, all three factors were identified.
FC2.37.06 SUBTOTAL HYSTERECTOMY LEADS TO IMPROVED SURVIVAL IN PATIENTS IN EXTREMIS WITH UTERINE RUPl?URE Raikumari Narone, MD, Jogendranath Narone, MD, Patna Medical College and Hospital, Patna, Bihar, India. Uterine rupture in a patient in extremis leads to significant maternal mortality. The aim of this paper is to evaluate subtotal hysterectomy (STH) vs. uterine repair (UR) for patients in extremis who present with uterine rupture. Between January 1993 and December 1998,39,667 hospital deliveries were carried out at an academic medical center in Bihar, India. Three hundred sixty seven patients presented with uterine rupture (incidence of uterine rupture was 1 in 108 deliveries) of which 96 patients presented in extremis, >20 hours delay in diagnosis, and an irregularly torn uterus found at operation. Charts were retrospectively reviewed to compare patient populations undergoing STH vs. UR and their outcomes. Results were analyzed using Fisher’s exact test. Sixty-one patients underwent subtotal hysterectomy (STH) while 35 underwent uterine repair (UR). There was no significant difference in the two groups with respect to patient age, parity, cause of rupture, and clinical condition at time of evaluation (p>O.2). The operative time for STH was significantly less than UR, 35 min. vs. 57 min (p
FC2.37.07 ISOLATED RUPl?URE OF THE URINARY BLADDER DURING LABOUR: A 12.YEAR REVIEW S.M.Padhve. Dept. OB/GYN, Maternity Hospital, Kathmandu, Nepal. Objective: The aim of the study was to find the incidence of the isolated rupture of the bladder during labor and review some of the literature. Study Methods: The case notes provisionally diagnosed as “Rupture of the Uterus” were studied. This is a retrospective study. One hundred and twenty case notes labeled as “Rupture of the Uterus” - (provisionally