MATERIALS AND METHODS
This retrospective study was conducted in the department of obstetrics and gynecology of two hospitals(One tertiary center, one government hospital) over a period of 23 years. This study was approved by the Research Ethics Committee of the Eskisehir Osmangazi University Faculty of Medicine (Ref. No: E.98130-2019/19). All women who underwent peripartum hysterectomy were included to the study population. The peripartum hytserectomy was defined as hysterectomy done after 24 weeks of gestation and with or within 24 hours of delivery. The datas of the patients were collected from the medical record of the hospitals. The records of the patients were reviewed for maternal characteristics such as age, gravidity, parity, gestational age, previous cesarean delivery, mode of delivery. The preoperative laboratory parameters and indications of surgery were also recorded. The exclusion criterias were as follows; delivery before 24 weeks of gestation and hysterectomy after 24 h of delivery. The type of the surgery, intraoperative and postoperative complications were investigated. The transfusion of blood products such as red blood cell and fresh frozen plasma that given during and after surgery were measured. The neonatal outcomes were also evaluated with birth weight and apgar scores. The patients were categorized as emergent and planned peripartum hysterectomy and the datas were compared according to this categorization. The emergent peripartum hysterectomy was approved as uncontrollable bleeding with conservative treatment modalities such as prostaglandins, oxytocics and baloon tamponade. The hysterectomies in emergency was performed especially in uncontrollable bleeding, and shock or if it was a previous hemodynamic or hemostatic restoration. Moreover, any type of vascular control was performed with hysterectomy in emergency if necessary. The planned peripartum hysterectomy was defined as planned cesarean hysterectomy generally scheduled at the 34 to 37 weeks of gestation. We scheduled the planned peripartum hysterectomy with a dedicated team that consist of experienced gynecologic oncologist and maternal fetal medicine specialist. The preoperative evaluation was performed to determine the specific markers of abnormal placentation with the using of gray-scale and doppler ultrasound. We administered antenatal corticosteroids before 34 weeks. We performed midline vertical incision and the uterus was entered at the fundus. The uterine incision was closed and the dissection of retroperitoneum and bladder was performed carefully by an experienced surgical team including a gynecologic oncologist. As far as possible, total abdominal hysterectomy was the main approach but subtotal hysterectomy was performed in some cases.
The Statistical Package for the Social Sciences(SPSS) Version 15.0(SPSS Inc., Chicago, IL) was used to analyze the datas. Demographic parameters and clinical outcomes were analyzed with mean±SD(standard deviation) and median values. Kolmogorov–Smirnov normality test was used to evalute the distribution of the parameters. Normally distributed datas were analyzed by using independent sample t test. Mann-Whitney U test was used to compare the non-parametric continuous and categorical datas. The percentages were compared with Pearson chi-square test or Fisher Exact test. A p value of <0.05 was considered statistically significant.