Objective Identify women undergoing peripartum hysterectomy and compare causes and management against standard derived from UKOSS (BJOG Sep2007).
Design Retrospective audit Jan 2005—Dec 2010
Method 18 patients identified through clinical coding and birth register. One patient excluded as had cancer of cervix.
Result Causes of haemorrhage: Uterine atony 53% (44.4% in our audit); Placenta praevia 38% (39% in our audit); Morbidly adherent placenta 38% (16.7% in our audit); One third of women had more than one cause (73% in our audit). There were (8%) reported uterine ruptures (5.6% in our audit),
Mode of delivery: 80% delivered by caesarean section (83.3% in our audit); 16% spontaneous vaginal delivery (none in our audit); 4% assisted vaginal delivery (16.7% in our audit).
Therapies used: syntocinon infusion, ergometrine, hemabate, misoprostol, bimanual compression, intrauterine ballon, brace suture, arterial ligation, factor v11a, arterial embolisation. In our audit arterial embolisation was not used. Cell saver used in 9 patients in our audit. Blood transfusion requirements were comparable.
Results for Local Standards
All cases had consultant presence.
First line uterotonics were used for all patients. 2nd line uterotonics were used in all cases of atonic haemorrhage.
Post natal debriefing of all patients
Cross match for all patients with placenta praevia, second stage delivery in theatre and patients with antibodies and if haemoglobin less than 8.5g/dl.
Recommendations Continuous audit of peripartum hysterectomies on yearly basis may be helpful to look for trends and preventable causes.
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