Following an unusual number of peripartum hysterectomies performed in the calendar year August 2011 to August 2012 in our district general hospital, we undertook a detailed review of the seven cases in which caesarean hysterectomies were necessitated by major obstetric haemorrhage, an incidence of about 12 per 10,000 deliveries, approximately three times the incidence quoted in UKOSS data.
Comparing these with the available national data regarding pathophysiology, we noted that the higher than expected incidence of placental implantation abnormalities were likely the causative factor (4 of 7 (57%) cases reviewed compared to 39% in national evidence). Evidence of good clinical practise was noted with respect to consent, appropriate staffing and involvement of senior clinicians. A range of measures were used prior to hysterectomy, including pharmacological treatments, haematological correction of coagulopathy, haemostatic brace sutures and uterine compression balloons.
While it is hoped that the number of cases represents a statistical ‘blip’ rather than an on-going trend, our experience emphasises the challenges faced by a busy district general hospital dealing with rising birth rates and increasing case complexity. We discuss the lessons learned from this case review, including the role of clinical governance and the benefit of open professional discussion.
Knight M on behalf of UKOSS. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG 2007;114:1380–1387.
Prevention and management of postpartum haemorrhage. RCOG Green Top Guideline No. 52. May 2009. RCOG.
Placenta praevia, placenta praevia accrete and vasa praevia: diagnosis and management. RCOG Green Top Guideline No 27. RCOG 2011.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.