Maija Jakobsson1, Anna-Maija Tapper2, Lotte Berdiin Colmorn3, Pelle G Lindqvist4, Kari Klungsøyr5,6, Lone Krebs7,8, Per E Børdahl9,10, Karin Gottvall11,12, Karin Källén12,13, Ragnheiður I Bjarnadóttir14, Jens Langhoff-Roos3, Mika Gissler15. 1. Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. 2. Hyvinkää Hospital Area, Helsinki and Uusimaa Hospital District, Helsinki, Finland. 3. Juliane Marie Centre, Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. 4. Department of Gynecology and Obstetrics, Clinitec, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. 5. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 6. Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway. 7. Department of Obstetrics and Gynecology, Holbaek Hospital, Holbaek, Denmark. 8. University of Copenhagen, Copenhagen, Denmark. 9. Department of Obstetrics and Gynecology, Haukeland University Hospital, Haukeland, Norway. 10. University of Bergen, Bergen, Norway. 11. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. 12. Epidemiology and Methodological Support Unit, Department of Evaluation and Analysis, National Board of Health and Welfare, Stockholm, Sweden. 13. Department of Obstetrics and Gynecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden. 14. Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland. 15. THL National Institute for Health and Welfare, Helsinki, Finland.
Abstract
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.
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.