Peripartum hysterectomy for management of hemorrhage
- Daniela A Carusi, MD, MSc
Daniela A Carusi, MD, MSc
- Assistant Professor of Obstetrics & Gynecology
- Harvard Medical School
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
Peripartum hysterectomy can be defined as a hysterectomy performed at the time, or within 24 hours, of delivery. Another definition is a hysterectomy performed any time from delivery to discharge from the same hospitalization. This topic will review the surgical planning, key operative points, and postoperative care for peripartum hysterectomy.
Related topics can be found separately and include:
●(See "Abdominal hysterectomy".)
EPIDEMIOLOGY AND RISK FACTORS
The most recent population-level study shows a peripartum hysterectomy rate of nearly one per 1000 deliveries (eg, 0.1 percent) in the United States . In addition to abnormal placentation, other significant risk factors for peripartum hysterectomy include advanced maternal age and parity, multiple gestations, antepartum bleeding, preeclampsia, bleeding disorders, and the use of assisted reproductive technologies [2-7]. While the majority of patients with these risk factors will experience neither major hemorrhage nor hysterectomy, patients who have multiple risk factors or a history of prior postpartum hemorrhage should deliver in a setting where hysterectomy is readily available if needed.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EPIDEMIOLOGY AND RISK FACTORS
- SURGICAL PLANNING
- Preoperative risk assessment
- Patient counseling
- Scheduling delivery of patients at high risk for cesarean hysterectomy
- Total versus supracervical hysterectomy
- Placement of hypogastric artery balloon catheters
- Preoperative preparation
- OPERATIVE PROCEDURE
- Key points
- Incision and delivery
- - Evaluation of bladder and ureteral integrity
- - Inspection and closure
- CONTROL OF PERSISTENT PELVIC BLEEDING
- Hemostatic agents
- Pelvic packing
- POSTOPERATIVE CARE
- Bladder care
- SUMMARY AND RECOMMENDATIONS