RESUMO
BACKGROUND: We investigated the indications for and maternal and perinatal outcomes following peripartum hysterectomy in a single large tertiary centre. MATERIALS AND METHODS: All cases of peripartum hysterectomy between 2000 and 2011 were investigated. Data regarding maternal demographics, previous obstetric and gynaecological history, indications for hysterectomy, and details of haemorrhage, surgical complications and neonatal outcomes were collected. RESULTS: There were 47 cases of peripartum hysterectomy of 55 262 births giving an incidence of 0.85 per 1000 births. Forty-one cases were total hysterectomies, while six were subtotal procedures. A total of 70.2% of cases were performed because of a morbidly adherent placenta, 27.7% for uterine atony and 2.1% for uterine rupture. The median estimated blood loss was 7290 mL. The overall surgical complication rate was 44.6% with bladder injury (19.1%) and sepsis (12.8%) commonest. Intensive care admission was required in 57.4% of women. CONCLUSIONS: Peripartum hysterectomy is a major procedure carrying a high morbidity rate. In this series, maternal survival was 100%.
Assuntos
Histerectomia , Placenta Acreta/cirurgia , Hemorragia Pós-Parto/cirurgia , Inércia Uterina/cirurgia , Ruptura Uterina/cirurgia , Adulto , Peso ao Nascer , Transfusão de Sangue , Cuidados Críticos , Feminino , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Histerectomia/efeitos adversos , Recém-Nascido , Nascido Vivo , Londres , Masculino , Período Periparto , Hemorragia Pós-Parto/terapia , Gravidez , Estudos Retrospectivos , Sepse/etiologia , Centros de Atenção Terciária , Bexiga Urinária/lesões , Adulto JovemRESUMO
OBJECTIVE: We correlated the prenatal severity with the postnatal outcome of prenatally detected renal pelvic dilatation (RPD). METHODS: Cases of prenatally detected RPD referred between January 2002 and December 2008 were included. Severe RPD was defined as an anterior-posterior diameter of 15 mm, mild and moderate dilatation was defined as 6 to <10 mm and 10 to <15 mm, respectively. Postnatal diagnosis, the need for surgery and the correlation with the prenatal severity was ascertained. RESULTS: Of the 762 patients with RPD, 492 (64.5%) were mild, 167 (21.9%) were moderate, and 103 (13.5%) were severe. The male:female ratio for the severe cohort was 5:1. Of the sever cases, 68% had progressive dilatation. Of the mild/moderate cases, 5% progressed to severe dilatation. PUJ obstruction was confirmed in 48 cases (60.8%), severe VUR in 11 cases (14%), VUJ obstruction in 5 cases (6%), PUV in 2 cases (2.5%), and a nonidentifiable cause in 13 cases (16.5%). Ten of the 48 (20.8%) babies with PUJ obstruction required surgery within the first year of life. CONCLUSION: An obstructive cause is usually present in severe cases, which are more likely to require surgery if there is PUJ obstruction. A high male:female ratio was present in this group.