Database : MEDLINE
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[PMID]: 29202781
[Au] Autor:Cooper K; Brown S
[Ad] Address:Department Obstetrics, Gynecology and Reproductive Sciences, Burlington, VT, 05401, USA. kylie.cooper@uvmhealth.org.
[Ti] Title:ACTA2 mutation and postpartum hemorrhage: a case report.
[So] Source:BMC Med Genet;18(1):143, 2017 12 04.
[Is] ISSN:1471-2350
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: ACTA2 encodes smooth muscle specific α-actin, a critical component or the contractile complex of vascular smooth muscle. Mutations in ACTA2 are the most common genetic cause of thoracic aortic aneurysm, and are also the cause of other disorders, including Moyamoya disease, coronary artery disease and stroke as well as Multisystemic Smooth Muscle Dysfunction Syndrome. We note that ACTA2 is also expressed in uterine smooth muscle, and this raises the possibility that women harboring ACTA2 mutations might exhibit uterine smooth muscle dysfunction. CASE PRESENTATION: We present a young woman whose ACTA2 mutation was ascertained during pregnancy because of her father's history of dissecting aneurysms. She was delivered at full term by cesarean section and subsequently had severe uterine hemorrhage due to uterine atony. Although her atony was successfully treated with uterotonic medications, she required blood transfusion. CONCLUSIONS: This case raises the possibility that women with ACTA2 mutations may be at risk of uterine muscle dysfunction and hemorrhage. Obstetricians should be alerted to and prepared for this possibility.
[Mh] MeSH terms primary: Actins/genetics
Mutation, Missense
Postpartum Hemorrhage/genetics
[Mh] MeSH terms secundary: Adult
Amino Acid Substitution
Aneurysm, Dissecting/complications
Aneurysm, Dissecting/genetics
Female
Genetic Predisposition to Disease
Humans
Infant, Newborn
Male
Pregnancy
Pregnancy Complications, Cardiovascular/genetics
Uterine Inertia/genetics
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (ACTA2 protein, human); 0 (Actins)
[Em] Entry month:1712
[Cu] Class update date: 171231
[Lr] Last revision date:171231
[Js] Journal subset:IM
[Da] Date of entry for processing:171206
[St] Status:MEDLINE
[do] DOI:10.1186/s12881-017-0505-5

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[PMID]: 29127939
[Au] Autor:Liu J; Peng C; Zhou QM; Guo L; Liu ZH; Xiong L
[Ad] Address:State Key Laboratory Breeding Base of Systematic Research, Development and Utilization of Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China; School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
[Ti] Title:Alkaloids and flavonoid glycosides from the aerial parts of Leonurus japonicus and their opposite effects on uterine smooth muscle.
[So] Source:Phytochemistry;145:128-136, 2017 Nov 08.
[Is] ISSN:1873-3700
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:The crude extract and some Chinese patented medicines of Leonurus japonicus Houtt. have been proven to affect the uterine smooth muscle. L. japonicus injection is widely used in obstetric departments in China for treating postpartum hemorrhage caused by uterine inertia. Bioassay-guided isolation of the 95% EtOH extract of L. japonicus yielded four cyclopeptides, nine alkaloids, and three flavonoid glycosides, including two previously undescribed cyclopeptides, namely, cycloleonuripeptide G and cycloleonuripeptide H. The structures of the cyclopeptides were elucidated to be cyclo-(L-Phe-L-Phe-Gly-L-Pro-Gly-L-Pro) and cyclo-(L-Phe-L-Ala-L-Pro-L-Ile-L-His-Gly-L-Ala-L-Pro), respectively, via spectroscopic and chemical methods. Cyclopeptides (cycloleonuripeptides C and D) and alkaloids (imperialine-3ß-D-glucoside and leonurine) promoted contraction of uterine smooth muscle strips isolated from normal rats. However, it was observed that flavonoid glycosides (spinosin, linarin, and apigenin-7-O-ß-D-glucopyranoside) significantly inhibited contraction of the uterine smooth muscle strips.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171111
[Lr] Last revision date:171111
[St] Status:Publisher

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[PMID]: 28502758
[Au] Autor:Marshall AL; Durani U; Bartley A; Hagen CE; Ashrani A; Rose C; Go RS; Pruthi RK
[Ad] Address:Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address: marshall.ariela@mayo.edu.
[Ti] Title:The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a National Inpatient Sample-based analysis.
[So] Source:Am J Obstet Gynecol;217(3):344.e1-344.e6, 2017 Sep.
[Is] ISSN:1097-6868
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Postpartum hemorrhage is a major cause of maternal morbidity and mortality, but the association between postpartum hemorrhage and hospital length of stay has not been rigorously investigated. OBJECTIVE: We explored the impact of postpartum hemorrhage on hospital length of stay and inpatient mortality, as these outcomes have both clinical and economic significance. STUDY DESIGN: We performed a retrospective analysis using data from the National Inpatient Sample database during the 2012 through 2013 time period. Deliveries were classified as postpartum hemorrhage due to uterine atony, nonatonic postpartum hemorrhage, or not complicated by postpartum hemorrhage (nonpostpartum hemorrhage). Average length of stay and inpatient mortality rates were compared between groups. RESULTS: Over the study interval, postpartum hemorrhage occurred in 3% of deliveries. Among deliveries complicated by postpartum hemorrhage, 76.6% were attributed to uterine atony and 23.4% were nonatonic. Women with nonatonic postpartum hemorrhage had the highest average length of stay (3.67 days) followed by atonic postpartum hemorrhage (2.98 days) and nonpostpartum hemorrhage (2.63 days); P < .001, all comparisons. Inpatient mortality rate of nonatonic postpartum hemorrhage over the entire study period was 104 per 100,000 compared to 019 per 100,000 for atonic postpartum hemorrhage and 3 per 100,000 for nonpostpartum hemorrhage deliveries (P < .001). CONCLUSION: From 2012 through 2013, women with postpartum hemorrhage experienced significantly longer length of stay and higher inpatient mortality rates than women without postpartum hemorrhage, largely attributable to nonatonic causes of postpartum hemorrhage. As hospital length of stay and inpatient mortality are important outcomes from both clinical and societal perspectives, interventions to reduce morbidity and mortality related to postpartum hemorrhage may simultaneously facilitate delivery of more cost-effective care and improve both maternal and population health.
[Mh] MeSH terms primary: Hospital Mortality
Length of Stay/statistics & numerical data
Postpartum Hemorrhage/epidemiology
[Mh] MeSH terms secundary: Adult
Female
Humans
Pregnancy
Retrospective Studies
United States/epidemiology
Uterine Inertia/epidemiology
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170918
[Lr] Last revision date:170918
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:170516
[St] Status:MEDLINE

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[PMID]: 28302085
[Au] Autor:Bracco F; Masini M; De Tonetti G; Brogioni F; Amidani A; Monichino S; Maltoni A; Dato A; Grattarola C; Cordone M; Torre G; Launo C; Chiorri C; Celleno D
[Ad] Address:Department of Educational Sciences, University of Genoa, Corso A. Podestà, 2, 16128, Genoa, Italy. fabrizio.bracco@unige.it.
[Ti] Title:Adaptation of non-technical skills behavioural markers for delivery room simulation.
[So] Source:BMC Pregnancy Childbirth;17(1):89, 2017 Mar 17.
[Is] ISSN:1471-2393
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room). METHODS: The MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected. RESULTS: The mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories. CONCLUSION: The MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation.
[Mh] MeSH terms primary: Clinical Competence
Eclampsia/therapy
Emergencies
Patient Care Team
Postpartum Hemorrhage/therapy
Seizures/therapy
Simulation Training
Uterine Inertia/therapy
[Mh] MeSH terms secundary: Adult
Anesthesiology/education
Cognition
Communication
Delivery Rooms
Female
Formative Feedback
Humans
Interprofessional Relations
Male
Maternal-Child Nursing/education
Middle Aged
Midwifery/education
Obstetrics/education
Postpartum Hemorrhage/etiology
Pregnancy
Seizures/etiology
Social Skills
Uterine Hemorrhage/therapy
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171023
[Lr] Last revision date:171023
[Js] Journal subset:IM
[Da] Date of entry for processing:170318
[St] Status:MEDLINE
[do] DOI:10.1186/s12884-017-1274-z

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[PMID]: 28177993
[Au] Autor:Kocaay AF; Oztuna D; Su FA; Elhan AH; Kuzu MA
[Ad] Address:1Department of Surgery, Ankara University, Ankara, Turkey 2Department of Biostatistics, Ankara University, Ankara, Turkey 3Department of Obstetrics and Gynecology, Dr Zekai Tahir Burak Women Health Research and Education Hospital, Ankara, Turkey.
[Ti] Title:Effects of Hysterectomy on Pelvic Floor Disorders: A Longitudinal Study.
[So] Source:Dis Colon Rectum;60(3):303-310, 2017 Mar.
[Is] ISSN:1530-0358
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Hysterectomy might adversely affect pelvic floor functions and result in many different symptoms, such as urinary and anal incontinence, obstructed defecation, and constipation. OBJECTIVE: The aim of this prospective study was to evaluate the influence of hysterectomy on pelvic floor disorders. DESIGN: This was a prospective and longitudinal study. SETTINGS: The study was conducted at the Ankara University Department of Surgery and the Dr Zekai Tahir Burak Women's Health Research and Education Hospital between September 2008 and March 2011. PATIENTS: The study was performed on patients who underwent hysterectomy for benign pathologies. MAIN OUTCOME MEASURES: A questionnaire about urinary incontinence (International Continence Society scoring), anal incontinence, constipation, and obstructed defecation (Rome criteria and constipation severity score), along with an extensive obstetric history, was administered preoperatively and postoperatively annually for 4 years. RESULTS: Patients (N = 327) who had completed each of the 4 annual postoperative follow-ups were included in this study. Compared with the preoperative observations, the occurrence of each symptom was significantly increased at each of the follow-up years (p < 0.001). Over the 4 postoperative years, the frequencies for constipation (n = 245) were 7.8%, 8.2%, 8.6%, and 5.3%; those for obstructed defecation (n = 269) were 4.5%, 5.2%, 4.1%, and 3.0%; those for anal incontinence (n = 252) were 4.8%, 6.3%, 6.0%, and 5.2%, and those for urinary incontinence (n = 99) were 12.1%, 12.1%, 11.1%, and 13.1%. In addition, patients who had no preoperative symptom (n = 70) from any of the selected symptoms showed a postoperative occurrence of at least 1 of these symptoms of 15.8%, 14.3%, 11.4%, and 8.6% for the postoperative years 1, 2, 3, and 4. LIMITATIONS: Although the study had several limitations, no comparison with a control population was the most important one. CONCLUSIONS: Hysterectomy for benign gynecologic pathologies had a significant negative impact on pelvic floor functions in patients who had no previous symptoms.
[Mh] MeSH terms primary: Hysterectomy/adverse effects
Pelvic Floor Disorders/etiology
Postoperative Complications/etiology
[Mh] MeSH terms secundary: Adult
Aged
Constipation/etiology
Fallopian Tubes/surgery
Fecal Incontinence/etiology
Female
Humans
Hysterectomy, Vaginal/adverse effects
Intestinal Obstruction/etiology
Longitudinal Studies
Middle Aged
Ovariectomy
Prospective Studies
Urinary Incontinence/etiology
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1702
[Cu] Class update date: 170406
[Lr] Last revision date:170406
[Js] Journal subset:IM
[Da] Date of entry for processing:170209
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000786

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[PMID]: 28317612
[Au] Autor:Simões CR; Vassalo FG; Lourenço ML; de Souza FF; Oba E; Sudano MJ; Prestes NC
[Ad] Address:Department of Animal Reproduction, Universidade Estadual Paulista, UNESP, Botucatu, Sao Paulo, Brazil.
[Ti] Title:Hormonal, Electrolytic, and Electrocardiographic Evaluations in Bitches With Eutocia and Dystocia.
[So] Source:Top Companion Anim Med;31(4):125-129, 2016 Dec.
[Is] ISSN:1946-9837
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The objective of the study was to assess clinical alterations, electrocardiographic, hematological, biochemical, hemogasometric, electrolytic, and hormone plasma concentrations in bitches with eutocia and dystocia. Overall, 28 bitches (dystocia, n = 22 and eutocia, n = 6) were assessed. The evaluations were performed at 2 time points, M1 (1 hour prepartum-eutocia group and cesarean or clinical intervention-dystocia group) and M2 (postpartum-eutocia or dystocia group and anesthetic recovery-dystocia group). The main clinical finding was the hypothermia (mean: 36.9°C dystocia vs. 36.8°C eutocia). Sinus arrhythmia and tachycardia were the electrocardiographic parameters predominant in eutocia and sinus rhythm in dystocia group. The P wave amplitude, heart rate, creatinine concentration, hematocrit, and hemoglobin were increased in M1 (P < .05), whereas the concentration of TCO was higher in M2. There was an increase in P concentration in dystocia and total T concentrations were increased in M1 in both groups. Total T was higher in dystocia during M1 and in dystocia during M2 in eutocia than in dystocia. We concluded that at 1 hour prepartum or pre-cesarean, there is an increase in heart rate in bitches with eutocia or dystocia, and this finding was correlated to thyroid hormone concentration. P concentrations remained high during dystocia, and hematological and biochemical changes returned to normal after parturition. The evaluation of these parameters in pregnancy can be used as tool to prevent dystocia and consequent fetal death.
[Mh] MeSH terms primary: Dog Diseases/blood
Dystocia/veterinary
Uterine Inertia/veterinary
[Mh] MeSH terms secundary: Animals
Blood Gas Analysis/veterinary
Body Temperature Regulation
Dog Diseases/physiopathology
Dogs
Dystocia/blood
Dystocia/physiopathology
Electrocardiography/veterinary
Female
Heart Rate
Hormones/blood
Pregnancy
Uterine Inertia/blood
Uterine Inertia/physiopathology
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Nm] Name of substance:0 (Hormones)
[Em] Entry month:1708
[Cu] Class update date: 170821
[Lr] Last revision date:170821
[Js] Journal subset:IM
[Da] Date of entry for processing:170321
[St] Status:MEDLINE

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[PMID]: 28292059
[Au] Autor:Kehila M; Derouich S; Chelli D; Touhami O; Marzouk SB; Khedher SB; Chanoufi MB; Boudaya F
[Ad] Address:Service C, Centre de Maternité et de Néonatologie de Tunis, Faculté de médecine de Tunis, Université Tunis El Manar, Tunisie.
[Ti] Title:Quelle stratégie chirurgicale adopter devant une hémorragie du post-partum et comment améliorer les résultats de la ligature des artères hypogastriques? [Which surgical strategy to adopt for the management of postpartum haemorrhage and how to improve the effects of hypogastric arteries ligation?]
[So] Source:Pan Afr Med J;25:96, 2016.
[Is] ISSN:1937-8688
[Cp] Country of publication:Uganda
[La] Language:fre
[Ab] Abstract:The objective were to identify the success factors of bilateral hypogastric arteries ligation and to assess its role in surgical treatment of postpartum hemorrhages. We conducted a retrospective study of all the cases of postpartum hemorrhage requiring surgical treatment between January 2008 and December 2011. The study included 88 patients (0,47% of all births). Uterine atony was the most common etiology (64,8 % of patients). Bilateral ligation of the hypogastric arteries was performed in 81.8% of patients. When surgery was the first choice treatment, its success rate was 66%. This rate was variable depending on the etiology of hemorrhage, the presence or the absence of hemostasis disorders and the time between diagnosis and surgical treatment. In case of uterine atony, the association with a second conservative technique, when the first was inadequate, helped stop the bleeding in 98% of cases. Ligation of hypogastric arteries is an effective surgical technique for the treatment of postpartum hemorrhage. Its success rate has increased thanks to early implementation and to the association with other conservative techniques.
[Mh] MeSH terms primary: Iliac Artery/surgery
Postpartum Hemorrhage/surgery
Uterine Inertia
[Mh] MeSH terms secundary: Adolescent
Adult
Female
Humans
Ligation
Postpartum Hemorrhage/etiology
Pregnancy
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1703
[Cu] Class update date: 170330
[Lr] Last revision date:170330
[Js] Journal subset:IM
[Da] Date of entry for processing:170316
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2016.25.96.9242

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[PMID]: 27855051
[Au] Autor:Carrillo-Gaucín S; Torres-Gómez LG
[Ad] Address:Servicio de Ginecología y Obstetricia, Hospital General de Subzona 13, Instituto Mexicano del Seguro Social, Ciudad Acuña, Coahuila, México. luis.torresg@imss.gob.mx.
[Ti] Title:Carbetocina y oxitocina: prevención de hemorragia posparto en pacientes con factores de riesgo para atonía uterina. [Carbetocin and oxytocin: Prevention of postpartum hemorrhage in patients with risk factors for uterine atony].
[So] Source:Rev Med Inst Mex Seguro Soc;54 Suppl 3:S284-S290, 2016.
[Is] ISSN:0443-5117
[Cp] Country of publication:Mexico
[La] Language:spa
[Ab] Abstract:BACKGROUND: In Mexico, during 2010, obstetric hemorrhage was second (19.6%) as a direct cause of maternal death. The aim of this paper is to evaluate the effect of oxytocin and carbetocin, in preventing postpartum hemorrhage in patients with risk factors for uterine atony. METHODS: Study type clinical trial, patients experiencing at least one of the risk factors for uterine atony included. Randomly, they were divided into two groups: one was given Oxytocin and other received Carbetocin. The following variables were determined: risk factors for uterine atony, hemoglobin and hematocrit, vital signs, trans-surgical bleeding, whether or not presented uterine atony, uresis, need for additional tonics uterus and need for blood transfusion. RESULTS: A total of 120 patients were studied in 6 months were excluded 3, 60 were treated with Carbetocin, and 57 with Oxytocin. It was determined that there is a greater number of events of uterine atony (p = 0.007, with RR 11.06) and therefore greater need for additional tonic uterus (p = 0.027, with RR 5.44) in the group of Oxytocin. There was no statistically significant difference in the other variables. CONCLUSIONS: Carbetocin is recommended as prophylaxis of obstetric hemorrhage in patients with risk factors for uterine atony.
[Mh] MeSH terms primary: Oxytocics/therapeutic use
Oxytocin/analogs & derivatives
Oxytocin/therapeutic use
Postpartum Hemorrhage/prevention & control
Uterine Inertia/drug therapy
[Mh] MeSH terms secundary: Adult
Double-Blind Method
Female
Humans
Postpartum Hemorrhage/etiology
Pregnancy
Risk Factors
Treatment Outcome
Uterine Inertia/etiology
[Pt] Publication type:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Name of substance:0 (Oxytocics); 50-56-6 (Oxytocin); 88TWF8015Y (carbetocin)
[Em] Entry month:1705
[Cu] Class update date: 170503
[Lr] Last revision date:170503
[Js] Journal subset:IM
[Da] Date of entry for processing:161118
[St] Status:MEDLINE

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[PMID]: 27825028
[Au] Autor:Campbell SM; Corcoran P; Manning E; Greene RA; Irish Maternal Morbidity Advisory Group
[Ad] Address:National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland.
[Ti] Title:Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland.
[So] Source:Eur J Obstet Gynecol Reprod Biol;207:56-61, 2016 Dec.
[Is] ISSN:1872-7654
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:BACKGROUND: The incidence of peripartum hysterectomy (PH) shows fifty-fold variation worldwide (0.2-10.5/1000 deliveries) and risk factors include advancing maternal age and parity, previous caesarean section (CS) and abnormal placentation. OBJECTIVES: In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend in PH incidence over 15 years since 1999; to assess risk of PH associated with morbidly adherent placenta (MAP), placenta praevia and postpartum haemorrhage (PPH) during 2005-2013; and to describe the causes, interventions and outcomes of PH cases during 2011-2013. STUDY DESIGN: For the 15-year time-trend analysis, PH cases and denominator data were extracted from Ireland's Hospital In-Patient Enquiry database. Multivariate Poisson regression analysis assessed risk of PH associated with MAP, placenta praevia and PPH. In collaboration with the 20 Irish maternity units we carried out a three-year national clinical audit of severe maternity morbidity. PH was a notifiable morbidity and the audit included detailed review of MOH cases. RESULTS: In 1999-2013 there were 298 PH cases, a rate of 0.32/1000 deliveries. During the period 2005-2013, the PH rate was 50 times higher in deliveries involving PPH, 100 times higher with placenta praevia and 1000 times higher with MAP. During the clinical audit (2011-2013) there were 65 PH cases, a rate of 0.33/1000 deliveries, increasing with advancing age and parity. The reporting of abnormal placentation, primarily the co-occurrence of placenta praevia and MAP, was linked with previous CS. Fifty-six of the 65 cases suffered MOH, most commonly associated with placenta praevia, MAP and uterine atony. Prophylactic and therapeutic uterotonic agents were appropriately used in the majority of cases. CONCLUSIONS: The incidence of PH in Ireland has been consistently low over 15 years, averaging one case every 3000 deliveries. The recognised risk factors of MAP, placenta praevia and PPH were independently associated with PH, with MAP being by far the strongest predictor. The vast majority of PH cases in our clinical audit were associated with MOH. Some deficiencies were noted in antenatal care, in certain elements of treatment and clinical governance protocols but adherence to guidelines was generally high.
[Mh] MeSH terms primary: Hysterectomy
Peripartum Period
Placenta Previa/surgery
Placenta, Retained/surgery
Postpartum Hemorrhage/prevention & control
Practice Patterns, Physicians´
Uterine Inertia/surgery
[Mh] MeSH terms secundary: Cesarean Section
Clinical Audit
Electronic Health Records
Female
Guideline Adherence
Humans
Hysterectomy/trends
Incidence
Ireland/epidemiology
Maternal Age
Obstetrics and Gynecology Department, Hospital
Parity
Placenta Previa/epidemiology
Placenta Previa/physiopathology
Placenta, Retained/epidemiology
Placenta, Retained/physiopathology
Postoperative Complications/etiology
Postoperative Complications/prevention & control
Postpartum Hemorrhage/etiology
Practice Patterns, Physicians'/trends
Pregnancy
Risk Factors
Severity of Illness Index
Uterine Inertia/epidemiology
Uterine Inertia/physiopathology
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1707
[Cu] Class update date: 170704
[Lr] Last revision date:170704
[Js] Journal subset:IM
[Da] Date of entry for processing:161109
[St] Status:MEDLINE

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[PMID]: 27824773
[Au] Autor:van den Akker T; Brobbel C; Dekkers OM; Bloemenkamp KW
[Ad] Address:Departments of Obstetrics and Clinical Epidemiology, Leiden University Medical Center, Leiden, and the Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, the Netherlands.
[Ti] Title:Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis.
[So] Source:Obstet Gynecol;128(6):1281-1294, 2016 Dec.
[Is] ISSN:1873-233X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To compare prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy across income settings. DATA SOURCES: PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases up to March 30, 2015. METHODS OF STUDY SELECTION: Studies including emergency peripartum hysterectomies performed within 6 weeks postpartum. Not eligible were comments, case reports, elective hysterectomies for associated gynecologic conditions, studies with fewer than 10 inclusions, and those reporting only percentages published in languages other than English or before 1980. Interstudy heterogeneity was assessed by χ test for heterogeneity; a random-effects model was applied whenever I exceeded 25%. TABULATION, INTEGRATION, AND RESULTS: One hundred twenty-eight studies were selected, including 7,858 women who underwent emergency peripartum hysterectomy, of whom 87% were multiparous. Hysterectomy complicated almost 1 per 1,000 deliveries (range 0.2-10.1). Prevalence differed between poorer (low and lower middle income) and richer (upper middle and high income) settings: 2.8 compared with 0.7 per 1,000 deliveries, respectively (relative risk 4.2, 95% confidence interval [CI] 4.0-4.5). Most common indications were placental pathology (38%), uterine atony (27%), and uterine rupture (26%). Risk indicators included cesarean delivery in the current pregnancy (odds ratio [OR] 11.38, 95% CI 9.28-13.97), previous cesarean delivery (OR 7.5, 95% CI 5.1-11.0), older age (mean difference 6.6 years between women in the case group and those in the control group, 95% CI 4.4-8.9), and higher parity (mean difference 1.4, 95% CI 0.7-2.2). Having attended antenatal care was protective (OR 0.12, 95% CI 0.06-0.25). Only 3% had accessed arterial embolization to prevent hysterectomy. Average blood loss was 3.7 L. Mortality was 5.2 per 100 hysterectomies (reported range 0-59.1) and higher in poorer settings: 11.9 compared with 2.5 per 100 hysterectomies (relative risk 4.8, 95% CI 3.9-5.9). CONCLUSION: Emergency peripartum hysterectomy is associated with considerable morbidity and mortality and is more frequent in lower-income countries, where it contains a higher risk of mortality. A (previous) cesarean delivery is associated with a higher risk of emergency peripartum hysterectomy.
[Mh] MeSH terms primary: Developed Countries/statistics & numerical data
Developing Countries/statistics & numerical data
Hysterectomy/statistics & numerical data
Uterine Hemorrhage/surgery
[Mh] MeSH terms secundary: Cesarean Section/statistics & numerical data
Emergencies
Female
Humans
Hysterectomy/adverse effects
Hysterectomy/mortality
Maternal Age
Peripartum Period
Placenta Diseases/surgery
Pregnancy
Prenatal Care/statistics & numerical data
Prevalence
Protective Factors
Risk Factors
Uterine Inertia/surgery
Uterine Rupture/surgery
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Entry month:1706
[Cu] Class update date: 170614
[Lr] Last revision date:170614
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:161109
[St] Status:MEDLINE


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