Karayalcin K, Ozcan S, Ozyer S, Mollamahmutoglu L, Danisman N. 2006 124(2):187–92.Ĭhristopoulos P, Hassiakos D, Tsitoura A, Panoulis K, Papadias K, Vitoratos N. Emergency peripartum hysterectomy: a prospective study in The Netherlands. Dell amputazione utero-ovarica come complement di taglio cescareo. A textbook of postpartum hemorrhage: a comprehensive guide to evaluation, management and surgical intervention: Jaypee Brothers Publishers 2006.
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As morbidity and sterilization are to be accepted results of PH, adequate postoperative patient care focusing not only on physiological but although on psychological sequelae is important. Postoperative maternal morbidity ranges from 26.5 to 31.5 % and mortality from PH is as high as 2.8–23.8 % with a mean of 4.8 %. When PH is inevitably required, clear decision making, involvement of an experienced obstetrician and prompt surgery goes along with a lower blood loss/transfusion requirement and an overall better patient outcome. EPH is to be performed before full-blown coagulopathy is established.
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In case of therapy refractory severe PPH any delay performing EPH significantly boosts the probability of DIC and as a consequence the mortality-risk in the patient. The latter requires a less complex surgical technique, reduces operating time, diminishes blood loss/need for blood transfusion and lowers intra- and postoperative complication rates. PH can either be performed in the more traditional way of total abdominal hysterectomy (TAH) or as supracervical uterine surgery (ASH, abdominal supracervical hysterectomy) depending on the patient’s condition, the indication for PH, the surgeon’s experience and the initial risk assessment for the probability of complications during and after the operation. Anatomical and physiological changes during pregnancy, responsible for potential intraoperative impediments, require adaptation of the surgical technique when compared to hysterectomy in gynecology. EPH is performed in one third following vaginal birth compared to two thirds of hysterectomies subsequent/during cesarean section (CS). The predominant indication for EPH is abnormal placentation (placenta previa/in−/percreta) – 45–73.3 %, uterine atony – 20.6–43 % or uterine rupture – 11.4–45.5 %. Beside a scheduled, preplanned PH (ultrasound diagnosis, infection) although a significant percentage of the patients who are at high risk for acute severe peripartum hemorrhage and the subsequent need for an EPH can be antenatally identified (= indication shift from the traditional “surprising” uterine atony to a more preplanned surgery especially for abnormal placentation). Considering a PH/obstetrician proportion of one operation every 11 years, surgical experience in this field is difficult to be kept up. Performance by a skilled obstetrical/surgical team reduces the high maternal morbidity and mortality associated with EPH. The incidence of PH in Europe is 1 in 2500 births.
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Emergency peripartum hysterectomy (EPH) is a most demanding obstetric surgery, performed in trying circumstances of life-threatening hemorrhage/disease that cannot be controlled by conventional methods. Peripartum hysterectomy (PH) is defined as a hysterectomy performed during or immediately after (<24 h) abdominal or vaginal delivery.