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- W4311897756 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." @default.
- W4311897756 created "2023-01-02" @default.
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- W4311897756 date "2022-11-30" @default.
- W4311897756 modified "2023-10-14" @default.
- W4311897756 title "Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide" @default.
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