Potentially avoidable peripartum hysterectomies in Denmark: A population based clinical audit

Lotte Berdiin Colmorn; Lone Krebs; Jens Langhoff-Roos; Maija Jakobsson; Anna Maija Tapper; Mika Gissler; Pelle Lindqvist; Lars Thurn; Karin Källen; Karin Gottvall; Kari Klungsoyr; Per E. Børdahl; Ragnheidur I. Bjarnadottir; Kathrine Birch Petersen; Lotte B. Colmorn; NOSS study group

doi:10.1371/journal.pone.0161302

Potentially avoidable peripartum hysterectomies in Denmark: A population based clinical audit

Lotte Berdiin Colmorn, Lone Krebs, Jens Langhoff-Roos, Maija Jakobsson, Anna Maija Tapper, Mika Gissler, Pelle Lindqvist, Lars Thurn, Karin Källen, Karin Gottvall, Kari Klungsoyr, Per E. Børdahl, Ragnheidur I. Bjarnadottir, Kathrine Birch Petersen, Lotte B. Colmorn, NOSS study group

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Abstract

Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009-2012 and made short narratives of all cases. Results: The most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies. Conclusion: More than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.

Original language	English
Article number	e0161302
Journal	PLoS ONE
Volume	11
Issue number	8
Number of pages	10
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0161302
Publication status	Published - 2016

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Potentially Avoidable Peripartum Hysterectomies in Denmark: A Population Based Clinical AuditFinal published version, 179 KBLicence: CC BY

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Colmorn, L. B., Krebs, L., Langhoff-Roos, J., Jakobsson, M., Tapper, A. M., Gissler, M., Lindqvist, P., Thurn, L., Källen, K., Gottvall, K., Klungsoyr, K., Børdahl, P. E., Bjarnadottir, R. I., Petersen, K. B., Colmorn, L. B., & NOSS study group (2016). Potentially avoidable peripartum hysterectomies in Denmark: A population based clinical audit. PLoS ONE, 11(8), [e0161302]. https://doi.org/10.1371/journal.pone.0161302

Colmorn, LB, Krebs, L, Langhoff-Roos, J, Jakobsson, M, Tapper, AM, Gissler, M, Lindqvist, P, Thurn, L, Källen, K, Gottvall, K, Klungsoyr, K, Børdahl, PE, Bjarnadottir, RI, Petersen, KB, Colmorn, LB & NOSS study group 2016, 'Potentially avoidable peripartum hysterectomies in Denmark: A population based clinical audit', PLoS ONE, vol. 11, no. 8, e0161302. https://doi.org/10.1371/journal.pone.0161302

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title = "Potentially avoidable peripartum hysterectomies in Denmark: A population based clinical audit",

abstract = "Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009-2012 and made short narratives of all cases. Results: The most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies. Conclusion: More than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.",

author = "Colmorn, {Lotte Berdiin} and Lone Krebs and Jens Langhoff-Roos and Maija Jakobsson and Tapper, {Anna Maija} and Mika Gissler and Pelle Lindqvist and Lars Thurn and Karin K{\"a}llen and Karin Gottvall and Kari Klungsoyr and B{\o}rdahl, {Per E.} and Bjarnadottir, {Ragnheidur I.} and Petersen, {Kathrine Birch} and Colmorn, {Lotte B.} and {NOSS study group}",

year = "2016",

doi = "10.1371/journal.pone.0161302",

language = "English",

volume = "11",

journal = "PLoS Computational Biology",

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TY - JOUR

T1 - Potentially avoidable peripartum hysterectomies in Denmark

T2 - A population based clinical audit

AU - Colmorn, Lotte Berdiin

AU - Krebs, Lone

AU - Langhoff-Roos, Jens

AU - Jakobsson, Maija

AU - Tapper, Anna Maija

AU - Gissler, Mika

AU - Lindqvist, Pelle

AU - Thurn, Lars

AU - Källen, Karin

AU - Gottvall, Karin

AU - Klungsoyr, Kari

AU - Børdahl, Per E.

AU - Bjarnadottir, Ragnheidur I.

AU - Petersen, Kathrine Birch

AU - Colmorn, Lotte B.

AU - NOSS study group

PY - 2016

Y1 - 2016

N2 - Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009-2012 and made short narratives of all cases. Results: The most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies. Conclusion: More than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.

AB - Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management of the specific types of pregnancy and delivery complications leading to peripartum hysterectomy. We evaluated medical records of the 50 Danish women with peripartum hysterectomy identified in the Nordic Obstetric Surveillance Study 2009-2012 and made short narratives of all cases. Results: The most frequent indication for hysterectomy was hemorrhage. The two main initial causes were abnormally invasive placenta (26%) and lacerations (26%). Primary atony was third and occurred in 20%. Before hysterectomy another 26% had secondary atony following complications such as lacerations, retained placental tissue or coagulation defects. Of the 50 cases, 24% were assessed to be avoidable and 30% potentially avoidable. Hysterectomy following primary and secondary atony was assessed to be avoidable in 4/10 and 4/13 cases, respectively. Early sufficient suturing of lacerations and uterine ruptures, as well as a more widespread use of intrauterine balloons alone or in combination with uterine compression sutures (the sandwich model), could presumably have prevented about one fourth of the peripartum hysterectomies. Conclusion: More than 50% of peripartum hysterectomies seem to be avoidable by simple measures. In order to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations and reveal if they are generally applicable.

U2 - 10.1371/journal.pone.0161302

DO - 10.1371/journal.pone.0161302

M3 - Journal article

C2 - 27560802

AN - SCOPUS:84990062805

SN - 1932-6203

VL - 11

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 8

M1 - e0161302

ER -

Potentially avoidable peripartum hysterectomies in Denmark: A population based clinical audit

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