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.