Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS)

TY - JOUR

T1 - Emergency peripartum hysterectomy

T2 - results from the prospective Nordic Obstetric Surveillance Study (NOSS)

AU - Jakobsson, Maija

AU - Tapper, Anna Maija

AU - Colmorn, Lotte Berdiin

AU - Lindqvist, Pelle G

AU - Klungsøyr, Kari

AU - Krebs, Lone

AU - Børdahl, Per E.

AU - Gottvall, Karin

AU - Källen, Karin

AU - Bjarnadóttir, Ragnheiður I

AU - Langhoff-Roos, Jens

AU - Gissler, Mika

N1 - © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - OBJECTIVE: To assess the prevalence and risk factors of emergency peripartum hysterectomy.DESIGN: Nordic collaborative study.POPULATION: 605 362 deliveries across the five Nordic countries.METHODS: 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.MAIN OUTCOME MEASURES: Emergency peripartum hysterectomy rate.RESULTS: 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 (n = 91, 43.1%), atonic bleeding (n = 69, 32.7%), uterine rupture (n = 31, 14.7%), other bleeding disorders (n = 12, 5.7%), and other indications (n = 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).CONCLUSIONS: 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.

AB - OBJECTIVE: To assess the prevalence and risk factors of emergency peripartum hysterectomy.DESIGN: Nordic collaborative study.POPULATION: 605 362 deliveries across the five Nordic countries.METHODS: 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.MAIN OUTCOME MEASURES: Emergency peripartum hysterectomy rate.RESULTS: 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 (n = 91, 43.1%), atonic bleeding (n = 69, 32.7%), uterine rupture (n = 31, 14.7%), other bleeding disorders (n = 12, 5.7%), and other indications (n = 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).CONCLUSIONS: 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.

KW - Adult

KW - Cesarean Section

KW - Emergencies

KW - Female

KW - Humans

KW - Hysterectomy

KW - Incidence

KW - Maternal Mortality

KW - Placenta Accreta

KW - Population Surveillance

KW - Postpartum Hemorrhage

KW - Pregnancy

KW - Pregnancy, Prolonged

KW - Premature Birth

KW - Prevalence

KW - Prospective Studies

KW - Puerperal Disorders

KW - Scandinavian and Nordic Countries

KW - Stillbirth

KW - Uterine Rupture

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1111/aogs.12644

DO - 10.1111/aogs.12644

M3 - Journal article

C2 - 25845622

SN - 0001-6349

VL - 94

SP - 745

EP - 754

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 7

ER -