To determine the incidence, indication, association with caesarean section (CS) and outcome of emergency peripartum hysterectomy (EPH) in The Netherlands. Study design: All 100 Dutch obstetric departments were asked t...To determine the incidence, indication, association with caesarean section (CS) and outcome of emergency peripartum hysterectomy (EPH) in The Netherlands. Study design: All 100 Dutch obstetric departments were asked to participate in a prospective nationwide registration of EPH between 1 April 2002 and 1 April 2003. For every case, a form with questions about obstetrical history, current pregnancy and delivery,maternal and neonatal outcome was completed. Results: Eighty-nine (89% ) hospitals participated and registered in total 48 EPH. The estimated incidence of EPH is 0.33/1000 births. The main indication for EPH was placenta accreta (50% ), followed by uterine atony (27% ). There were two maternal deaths (4% ). Severe maternal morbidity included: urinary tract injury 15% , relaparotomy 25% , transfusion > 10 units red blood cells 67% , intensive care admission 77% . Both previous CS and CS in the index pregnancy were associated with a significant increased risk of EPH. The number of previous CS was related to an increased risk of placenta accreta, from 0.19% for one previous CS to 9.1% for four or more previous CS. Conclusion: Emergency peripartum hysterectomy is associated with a high incidence of maternal morbidity and a case fatality rate of 4% . It is significantly related to CS in index or previous pregnancy. Placenta accreta is the most common indication to perform a peripartum hysterectomy.展开更多
The aim of this study was to assess the preference of women with early pregnancy failure for treatment with misoprostol as compared to curettage. Study design: Women with early pregnancy failure were interviewed and a...The aim of this study was to assess the preference of women with early pregnancy failure for treatment with misoprostol as compared to curettage. Study design: Women with early pregnancy failure were interviewed and asked whether they were motivated to trade a non-invasive but potentially less effective treatment with misoprostol at the virtually 100% guarantee of complete evacuation after curettage. All women had a structured interview, in which they were informed about both treatment options. The women were asked for a treatment preference in case the complete evacuation rate after misoprostol was set at 100% . In case the women preferred misoprostol, the complete evacuation rate was subsequently decreased to 10% using steps of 5% . Results: The study group consisted of 64 women with early pregnancy failure. Seven women (11% )- did not opt for misoprostol at all, because of fear of pain or bleeding using misoprostol. Fifty percent of the women would prefer misoprostol if its complete evacuation rate exceeds 65% . Conclusion: A majority of women would prefer misoprostol over curettage if its complete evacuation rate exceeds 65% .展开更多
文摘To determine the incidence, indication, association with caesarean section (CS) and outcome of emergency peripartum hysterectomy (EPH) in The Netherlands. Study design: All 100 Dutch obstetric departments were asked to participate in a prospective nationwide registration of EPH between 1 April 2002 and 1 April 2003. For every case, a form with questions about obstetrical history, current pregnancy and delivery,maternal and neonatal outcome was completed. Results: Eighty-nine (89% ) hospitals participated and registered in total 48 EPH. The estimated incidence of EPH is 0.33/1000 births. The main indication for EPH was placenta accreta (50% ), followed by uterine atony (27% ). There were two maternal deaths (4% ). Severe maternal morbidity included: urinary tract injury 15% , relaparotomy 25% , transfusion > 10 units red blood cells 67% , intensive care admission 77% . Both previous CS and CS in the index pregnancy were associated with a significant increased risk of EPH. The number of previous CS was related to an increased risk of placenta accreta, from 0.19% for one previous CS to 9.1% for four or more previous CS. Conclusion: Emergency peripartum hysterectomy is associated with a high incidence of maternal morbidity and a case fatality rate of 4% . It is significantly related to CS in index or previous pregnancy. Placenta accreta is the most common indication to perform a peripartum hysterectomy.
文摘The aim of this study was to assess the preference of women with early pregnancy failure for treatment with misoprostol as compared to curettage. Study design: Women with early pregnancy failure were interviewed and asked whether they were motivated to trade a non-invasive but potentially less effective treatment with misoprostol at the virtually 100% guarantee of complete evacuation after curettage. All women had a structured interview, in which they were informed about both treatment options. The women were asked for a treatment preference in case the complete evacuation rate after misoprostol was set at 100% . In case the women preferred misoprostol, the complete evacuation rate was subsequently decreased to 10% using steps of 5% . Results: The study group consisted of 64 women with early pregnancy failure. Seven women (11% )- did not opt for misoprostol at all, because of fear of pain or bleeding using misoprostol. Fifty percent of the women would prefer misoprostol if its complete evacuation rate exceeds 65% . Conclusion: A majority of women would prefer misoprostol over curettage if its complete evacuation rate exceeds 65% .
