RESUMEN
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%.
Asunto(s)
Histerectomía , Placenta Accreta/cirugía , Hemorragia Posparto/cirugía , Inercia Uterina/cirugía , Rotura Uterina/cirugía , Adulto , Peso al Nacer , Transfusión Sanguínea , Cuidados Críticos , Femenino , Humanos , Hipoxia-Isquemia Encefálica/etiología , Histerectomía/efectos adversos , Recién Nacido , Nacimiento Vivo , Londres , Masculino , Periodo Periparto , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos , Sepsis/etiología , Centros de Atención Terciaria , Vejiga Urinaria/lesiones , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to investigate the perinatal outcome of prenatally diagnosed congenital talipes equinovarus. METHODS: This was a retrospective observational study of all cases of prenatally diagnosed congenital talipes equinovarus referred to a major tertiary fetal medicine unit. Cases were identified from the fetal medicine and obstetric databases and pregnancy details and delivery outcome data obtained. Details of termination of pregnancy, number of patients undergoing karyotyping as well as details of prenatal classification of severity were recorded. RESULTS: A total of 174 cases were identified. Of these, outcome data was available for 88.5% (154/174) of the pregnancies. Eighty three (47.7%) of cases were isolated and 91 cases (52.3%) were associated with additional abnormalities. There was a significant difference in birth weights between the two cohorts. Bilateral abnormality tended to be more severe. A high caesarean section rate was noted overall and a high preterm delivery rate seen in the isolated group. CONCLUSION: This study is important because it provides contemporary data that can be used to counsel women prenatally. In particular, the raised risk of preterm delivery and caesarean section as well as the increased severity of the condition when both feet are affected should be discussed. The poor perinatal outcome when additional anomalies are present and the increased risk of aneuploidy are also important factors.