Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage.

Hdl Handle:
http://hdl.handle.net/10147/217184
Title:
Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage.
Authors:
O'Brien, D; Babiker, E; O'Sullivan, O; Conroy, R; McAuliffe, F; Geary, M; Byrne, B
Affiliation:
UCD School of Medicine and Medical Science, Obstetrics & Gynaecology, National Maternity Hospital, Dublin, Ireland.
Citation:
Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage. 2010, 153 (2):165-9 Eur. J. Obstet. Gynecol. Reprod. Biol.
Journal:
European journal of obstetrics, gynecology, and reproductive biology
Issue Date:
Dec-2010
URI:
http://hdl.handle.net/10147/217184
DOI:
10.1016/j.ejogrb.2010.07.039
PubMed ID:
20810201
Abstract:
The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD).; This prospective study from 2004 to 2007 was carried out in three Dublin maternity hospitals. Women were identified as having MOH if they received ≥5 units of red cell concentrate (RCC) acutely. Risk factors for hysterectomy or end organ dysfunction were calculated using logistic regression.; One hundred and seventeen cases of MOH in 93,291 deliveries were identified (1.25/1000). The predominant cause was uterine atony. Haemostasis was achieved with medical therapy alone in 15% of cases. The hydrostatic balloon and the B-Lynch suture arrested bleeding in 75% and 40% of cases utilised respectively. Hysterectomy was required to arrest bleeding in 24% of women and 16% of women developed end organ dysfunction (11 had both). There was one maternal death. Independent risk factors for hysterectomy included the number of previous caesarean sections (OR 3.28, 95% CI 1.95-5.5), placenta praevia (OR 13.5, 95% CI 7.7-184), placenta accreta (OR 37.7, 95% CI 7.7-184), uterine rupture (OR 7.25, 95% CI 1.25-42) and the number of units of RCC transfused (OR 1.31, 95% CI 1.13-1.5). Independent risk factors for end organ dysfunction (EOD) were placenta accreta (OR 5, 95% CI 1.5-16.5), uterine rupture (OR 13.86, 95% CI 2.32-82), the number of RCC transfused (OR 1.31, 95% CI 1.13-1.5) and the minimum haematocrit recorded (OR 5.53, 95% CI 1.7-18).; MOH is complicated by hysterectomy in 24% and end organ dysfunction in 16% of cases. The risk of peripartum hysterectomy is increased with the number of previous caesarean sections, the aetiology of the bleed, namely placenta praevia/accreta or uterine rupture and the volume of blood transfused. Critically, failure to maintain optimal haematocrit during the acute event was associated with end organ dysfunction.
Language:
en
MeSH:
Blood Transfusion; Cesarean Section; Female; Humans; Hysterectomy; Multiple Organ Failure; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Uterine Rupture
ISSN:
1872-7654
Ethical Approval:
N/A

Full metadata record

DC FieldValue Language
dc.contributor.authorO'Brien, D-
dc.contributor.authorBabiker, E-
dc.contributor.authorO'Sullivan, O-
dc.contributor.authorConroy, R-
dc.contributor.authorMcAuliffe, F-
dc.contributor.authorGeary, M-
dc.contributor.authorByrne, B-
dc.date.accessioned2012-03-30T13:58:58Z-
dc.date.available2012-03-30T13:58:58Z-
dc.date.issued2010-12-
dc.identifier.citationPrediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage. 2010, 153 (2):165-9 Eur. J. Obstet. Gynecol. Reprod. Biol.-
dc.identifier.issn1872-7654-
dc.identifier.pmid20810201-
dc.identifier.doi10.1016/j.ejogrb.2010.07.039-
dc.identifier.urihttp://hdl.handle.net/10147/217184-
dc.description.abstractThe aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD).-
dc.description.abstractThis prospective study from 2004 to 2007 was carried out in three Dublin maternity hospitals. Women were identified as having MOH if they received ≥5 units of red cell concentrate (RCC) acutely. Risk factors for hysterectomy or end organ dysfunction were calculated using logistic regression.-
dc.description.abstractOne hundred and seventeen cases of MOH in 93,291 deliveries were identified (1.25/1000). The predominant cause was uterine atony. Haemostasis was achieved with medical therapy alone in 15% of cases. The hydrostatic balloon and the B-Lynch suture arrested bleeding in 75% and 40% of cases utilised respectively. Hysterectomy was required to arrest bleeding in 24% of women and 16% of women developed end organ dysfunction (11 had both). There was one maternal death. Independent risk factors for hysterectomy included the number of previous caesarean sections (OR 3.28, 95% CI 1.95-5.5), placenta praevia (OR 13.5, 95% CI 7.7-184), placenta accreta (OR 37.7, 95% CI 7.7-184), uterine rupture (OR 7.25, 95% CI 1.25-42) and the number of units of RCC transfused (OR 1.31, 95% CI 1.13-1.5). Independent risk factors for end organ dysfunction (EOD) were placenta accreta (OR 5, 95% CI 1.5-16.5), uterine rupture (OR 13.86, 95% CI 2.32-82), the number of RCC transfused (OR 1.31, 95% CI 1.13-1.5) and the minimum haematocrit recorded (OR 5.53, 95% CI 1.7-18).-
dc.description.abstractMOH is complicated by hysterectomy in 24% and end organ dysfunction in 16% of cases. The risk of peripartum hysterectomy is increased with the number of previous caesarean sections, the aetiology of the bleed, namely placenta praevia/accreta or uterine rupture and the volume of blood transfused. Critically, failure to maintain optimal haematocrit during the acute event was associated with end organ dysfunction.-
dc.language.isoen-
dc.rightsArchived with thanks to European journal of obstetrics, gynecology, and reproductive biologyen_GB
dc.subject.meshBlood Transfusion-
dc.subject.meshCesarean Section-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshHysterectomy-
dc.subject.meshMultiple Organ Failure-
dc.subject.meshPlacenta Accreta-
dc.subject.meshPlacenta Previa-
dc.subject.meshPostpartum Hemorrhage-
dc.subject.meshPregnancy-
dc.subject.meshProspective Studies-
dc.subject.meshUterine Rupture-
dc.titlePrediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage.en_GB
dc.contributor.departmentUCD School of Medicine and Medical Science, Obstetrics & Gynaecology, National Maternity Hospital, Dublin, Ireland.-
dc.identifier.journalEuropean journal of obstetrics, gynecology, and reproductive biology-
dc.type.qualificationlevelN/Aen
cr.approval.ethicalN/Aen
dc.description.provinceLeinsteren
dc.description.provinceLeinster-

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