Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS). (30th April 2015)

• Record Type: Journal Article
• Authors: Jakobsson, Maija; Tapper, Anna‐Maija; Colmorn, Lotte Berdiin; Lindqvist, Pelle G.; Klungsøyr, Kari; Krebs, Lone; Børdahl, Per E.; Gottvall, Karin; Källén, Karin; Bjarnadóttir, Ragnheiður I.; Langhoff‐Roos, Jens; Gissler, Mika; the NOSS study group
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 94:Number 7(2015)
• Page Start: 745
• Page End: 754
• Publication Date: 2015-04-30
• Subjects: Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12644
• Languages: English
• ISSNs: 0001-6349

Abstract

<abstract abstract-type="main" id="aogs12644-abs-0001"> <title>Abstract</title> <sec id="aogs12644-sec-0001" sec-type="section"> <title>Objective</title> <p>To assess the prevalence and risk factors of emergency peripartum hysterectomy.</p> </sec> <sec id="aogs12644-sec-0002" sec-type="section"> <title>Design</title> <p>Nordic collaborative study.</p> </sec> <sec id="aogs12644-sec-0003" sec-type="section"> <title>Population</title> <p>605 362 deliveries across the five Nordic countries.</p> </sec> <sec id="aogs12644-sec-0004" sec-type="section"> <title>Methods</title> <p>We collected data prospectively from patients undergoing emergency peripartum hysterectomy within 7 days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period.</p> </sec> <sec id="aogs12644-sec-0005" sec-type="section"> <title>Main outcome measures</title> <p>Emergency peripartum hysterectomy rate.</p> </sec> <sec id="aogs12644-sec-0006" sec-type="section"> <title>Results</title> <p>The total number of emergency peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10 000 (95% confidence interval 3.0–4.0) births. Finland had the highest prevalence (5.1) and Norway the lowest (2.9). Primary indications included an abnormally invasive placenta (<italic>n </italic>=<italic> </italic>91, 43.1%), atonic bleeding (<italic>n </italic>=<italic> </italic>69, 32.7%), uterine rupture (<italic>n </italic>=<italic> </italic>31, 14.7%), other bleeding disorders (<italic>n </italic>=<italic> </italic>12, 5.7%), and other indications (<italic>n </italic>=<italic> </italic>8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post‐term birth increased the risk for emergency peripartum hysterectomy. The number of stillbirths was substantially high (70/1000), but the case fatality rate stood at 0.47% (one death, maternal mortality rate 0.17/100 000 deliveries).</p> </sec> <sec id="aogs12644-sec-0007" sec-type="section"> <title>Conclusions</title> <p>A combination of prospective data collected from clinicians and information gathered from register‐based databases can yield valuable data, improving the registration accuracy for rare, near‐miss cases. However, proper and uniform clinical guidelines for the use of well‐defined international diagnostic codes are still needed.</p> </sec> </abstract>