Silent Abnormal Placentation Linkage to Peripartum
Hysterectomy: Thammasat University Hospital
6-Year Study†
Komsun Suwannarurk MD*,
Yuthadej Thaweekul MD*, Karicha Mairaing MD*,
Yenrudee Poomtavorn MD*, Kornkarn Bhamarapravatana PhD**
Affiliation :
† The abstract of this manuscript was presented on May 7-10, 2014 as a poster presentation at
the 23rd European Congress of Obstetrics and Gynaecology (EBCOG2014), Glasgow, Scotland
* Gynaecological Oncology Unit, Department of Obstetrics & Gynaecology, Faculty of Medicine,
Thammasat University, Pathumthani, Thailand
** Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Objective : To determine the prevalence, indications, types and complications of peripartum hysterectomy at Thammasat
University Hospital, Thailand.
Material and Method: A retrospective peripartum hysterectomy (PH) study. Data came from parturient who delivered at
Thammasat University Hospital, Pathumthani, Thailand between January 2007 and December 2012.
Results : In the period of 6 years, there were 37 cases of PH among 28,023 parturient. The overall prevalence of PH was
1.32 per 1,000 deliveries with average parturientage of 30. Nineteen hysterectomies were performed after vaginal delivery
(1.1/1,000) and the remaining 18 hysterectomies were performed after cesarean section (1.67/1,000). Seven cases (18.9%)
were performed as subtotal and the remaining 30 cases (81.1%) as total hysterectomy. Major indication of PH was uterine
atony (75.7%, 28/37) followed by abnormal placentation (10.8%, 4/37) and uterine rupture (5.4%, 2/37). From hysterectomy
specimens, placenta accreta, placenta increta and placenta percreta were found in 5, 3, and 3 cases, respectively. Two cases
of cervical intraepithelial neoplasia were later discovered from hysterectomy specimens. Three cases of placenta percreta
were associated with pre-operative diagnosis of placenta adherent, uterine rupture and placenta previa. The average
estimated blood loss was 2,416 ml. The overall surgical complication rate was 35.1% (13/37). The rate of reoperation,
maternal death, wound infection, gut obstruction and lung complications were 16.2, 8.1, 2.7, 2.7 and 2.7 percent, respectively.
Conclusion : Peripartum hysterectomy is a major, hazardous procedure carrying a high mortality and morbidity rate. In
this study, maternal mortality was 8.1%. Silent abnormal placentation was found in 21.2 percent (7/33) of hysterectomy
specimen.
Keywords : Peripartum, Hysterectomy, Hemorrhage, Pathology
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