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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
html.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).
html.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.
html.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).
html.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.


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