Open AccessEmergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study ( NOSS )
Author(s) -
Jakobsson Maija,
Tapper AnnaMaija,
Colmorn Lotte Berdiin,
Lindqvist Pelle G.,
Klungsøyr Kari,
Krebs Lone,
Børdahl Per E.,
Gottvall Karin,
Källén Karin,
Bjarnadóttir Ragnheiður I.,
LanghoffRoos Jens,
Gissler Mika
Publication year - 2015
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12644
Subject(s) - medicine , uterine atony , hysterectomy , obstetrics , case fatality rate , uterine rupture , incidence (geometry) , population , pregnancy , maternal death , surgery , physics , environmental health , uterus , biology , optics , genetics
Objective To assess the prevalence and risk factors of emergency peripartum hysterectomy. Design Nordic collaborative study. Population 605 362 deliveries across the five Nordic countries. Methods We collected data prospectively from patients undergoing emergency peripartum hysterectomy within 7 days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period. Main outcome measures Emergency peripartum hysterectomy rate. Results The total number of emergency peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10 000 (95% confidence interval 3.0–4.0) births. Finland had the highest prevalence (5.1) and Norway the lowest (2.9). Primary indications included an abnormally invasive placenta ( n = 91, 43.1%), atonic bleeding ( n = 69, 32.7%), uterine rupture ( n = 31, 14.7%), other bleeding disorders ( n = 12, 5.7%), and other indications ( n = 8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post‐term birth increased the risk for emergency peripartum hysterectomy. The number of stillbirths was substantially high (70/1000), but the case fatality rate stood at 0.47% (one death, maternal mortality rate 0.17/100 000 deliveries). Conclusions A combination of prospective data collected from clinicians and information gathered from register‐based databases can yield valuable data, improving the registration accuracy for rare, near‐miss cases. However, proper and uniform clinical guidelines for the use of well‐defined international diagnostic codes are still needed.