Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Issue 1 (30th January 2023)

• Record Type: Journal Article
• Authors: Kallianidis, Athanasios F.; Rijntjes, Douwe; Brobbel, Carolien; Dekkers, Olaf M.; Bloemenkamp, Kitty W. M.; van den Akker, Thomas
• Is Part Of: Obstetrics and gynecology. Volume 141:Issue 1(2023)
• Page Start: 35
• Page End: 48
• Publication Date: 2023-01-30
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/AOG.0000000000005022
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : The incidence, indications, management, and outcomes of emergency peripartum hysterectomy differ substantially across income settings. Abstract : OBJECTIVE: To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings. DATA SOURCES: PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021. METHODS OF STUDY SELECTION: Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8, 775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting. TABULATION, INTEGRATION, AND RESULTS: The meta-analysis included 154 studies: 14, 409 emergency peripartum hysterectomies were performed in 17, 127, 499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1, 000 births (95% CI 1.0–1.3). The highest incidence was observed in lower middle–income settings (3/1, 000 births, 95% CI 2.5–3.5), and the lowest incidence was observed in high-income settings (0.7/1, 000 births, 95% CI 0.5–0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9–42.4), uterine atony (27.0%, 95% CI 24.6–29.5), and uterine rupture (21.2%, 95% CI 17.8–25.0). In lower middle–income countries, uterine rupture (44.5%, 95% CI 36.6–52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5–53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2, 706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3–81.9). The most common complications were febrile (29.7%, 95% CI 25.4–34.3) and hematologic (27.5%, 95% CI 20.4–35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5–4.2) and was higher in lower middle–income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9–14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6–1.6). CONCLUSION: Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.