Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland

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dc.contributor.author Campbell, Sarah M.
dc.contributor.author Corcoran, Paul
dc.contributor.author Manning, Edel
dc.contributor.author Greene, Richard A.
dc.date.accessioned 2017-01-27T12:14:14Z
dc.date.available 2017-01-27T12:14:14Z
dc.date.issued 2016-10-27
dc.identifier.citation Campbell, S. M., Corcoran, P., Manning, E. and Greene, R. A. (2016) ‘Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland’, European Journal of Obstetrics and Gynecology and Reproductive Biology, 207, pp. 56-61. doi:10.1016/j.ejogrb.2016.10.008 en
dc.identifier.volume 207 en
dc.identifier.startpage 56 en
dc.identifier.endpage 61 en
dc.identifier.issn 0301-2115
dc.identifier.uri http://hdl.handle.net/10468/3531
dc.identifier.doi 10.1016/j.ejogrb.2016.10.008
dc.description.abstract Background: The incidence of peripartum hysterectomy (PH) shows fifty-fold variation worldwide (0.2–10.5/1000 deliveries) and risk factors include advancing maternal age and parity, previous caesarean section (CS) and abnormal placentation. Objectives: In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend in PH incidence over 15 years since 1999; to assess risk of PH associated with morbidly adherent placenta (MAP), placenta praevia and postpartum haemorrhage (PPH) during 2005–2013; and to describe the causes, interventions and outcomes of PH cases during 2011–2013. Study design: For the 15-year time-trend analysis, PH cases and denominator data were extracted from Ireland’s Hospital In-Patient Enquiry database. Multivariate Poisson regression analysis assessed risk of PH associated with MAP, placenta praevia and PPH. In collaboration with the 20 Irish maternity units we carried out a three-year national clinical audit of severe maternity morbidity. PH was a notifiable morbidity and the audit included detailed review of MOH cases. Results: In 1999–2013 there were 298 PH cases, a rate of 0.32/1000 deliveries. During the period 2005–2013, the PH rate was 50 times higher in deliveries involving PPH, 100 times higher with placenta praevia and 1000 times higher with MAP. During the clinical audit (2011–2013) there were 65 PH cases, a rate of 0.33/1000 deliveries, increasing with advancing age and parity. The reporting of abnormal placentation, primarily the co-occurrence of placenta praevia and MAP, was linked with previous CS. Fifty-six of the 65 cases suffered MOH, most commonly associated with placenta praevia, MAP and uterine atony. Prophylactic and therapeutic uterotonic agents were appropriately used in the majority of cases. Conclusions: The incidence of PH in Ireland has been consistently low over 15 years, averaging one case every 3000 deliveries. The recognised risk factors of MAP, placenta praevia and PPH were independently associated with PH, with MAP being by far the strongest predictor. The vast majority of PH cases in our clinical audit were associated with MOH. Some deficiencies were noted in antenatal care, in certain elements of treatment and clinical governance protocols but adherence to guidelines was generally high. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Elsevier Ltd en
dc.rights © 2016, Elsevier Ireland Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license. en
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.subject Peripartum hysterectomy en
dc.subject Major obstetric haemorrhage en
dc.subject Postpartum haemorrhage en
dc.subject Caesarean section en
dc.subject Morbidly adherent placenta en
dc.subject Placenta praevia en
dc.title Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Richard Greene, Obstetrics & Gynaecology, University College Cork, Cork, Ireland. +353-21-490-3000 Email: r.greene@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2017-10-27
dc.date.updated 2017-01-27T11:57:03Z
dc.description.version Accepted Version en
dc.internal.rssid 381255330
dc.contributor.funder Health Service Executive, Ireland
dc.description.status Peer reviewed en
dc.identifier.journaltitle European Journal of Obstetrics and Gynecology and Reproductive Biology en
dc.internal.copyrightchecked Yes en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress r.greene@ucc.ie en


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© 2016, Elsevier Ireland Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license. Except where otherwise noted, this item's license is described as © 2016, Elsevier Ireland Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license.
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