Postpartum hysterectomy in the university maternity hospital (a retrospective statistical study)

Postpartum hysterectomy in the university maternity hospital (a retrospective statistical study) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Postpartum hysterectomy in the university maternity hospital (a retrospective statistical study) Mohannad mohammed nazir yasmineh, Dalal mohamad emad aldin Alhamwi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3972445/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To study the file of patients who underwent obstetric hysterectomy and learn the indications, risk factors, and complications to reduce its occurrence as much as possible. Type of study: retrospective cohort study Place of study: Obstetrics and Gynecology University Hospital in Damascus - Records of the Archives Division. Study period: starting from 1/1/2016 until 12/31/2022. Patients: The study sample included 124 women admitted to the University Obstetrics and Gynecology Hospital who underwent obstetric hysterectomy. Results 91.9.9% of the patients had a natural birth, while 8.1% had a cesarean section. The rate of performing a total hysterectomy was 1.47/1000, within seven years. The rate of it being performed among patients with a cesarean section was 3.12/1000, and the rate of it being performed among patients with a natural birth was 0.2/1000. The most common indication for a postpartum hysterectomy is placenta accreta (54%), and the most common complication of obstetric hysterectomy is urinary tract injury (22%). Conclusion Congenital hysterectomy is highly associated with cesarean section, and because of the high risk associated with cesarean section, the decision to perform cesarean section should be made when its benefits outweigh the potential risks. Obstetrics & Gynecology postpartum hysterectomy university maternity hospital retrospective cohort study Introduction A peripartum hysterectomy can be done at any point between giving birth and being released from the hospital. When conservative methods fail to manage significant uterine hemorrhage, peripartum hysterectomy is the recommended course of action [ 1 ]. A "near-miss" maternal event is a peripartum hysterectomy, which is an operation done to save a woman's life in a potentially fatal obstetric scenario [ 2 ]. It causes a decline in fertility and is linked to high rates of illness and mortality in mothers [ 3 ]. The incidence of peripartum hysterectomy varies greatly across the globe. Peripartum hysterectomy complicates fewer than one delivery out of every 1000 in high-income countries [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ], but in Nigeria [ 11 ] and Pakistan [ 12 ], the incidence is 4 and 11 per 1000 deliveries, respectively. Over time, there has been an increase in the number of emergency peripartum hysterectomies [ 7 , 8 , 9 , 13 , 14 , 15 ]. It rose by 15% between 1995 and 2007 [ 13 ] and by 12% between 1998 and 2003 [ 9 ] in the USA. Advanced maternal age, aberrant placentation, increased parity, and cesarean delivery in a previous or ongoing pregnancy are risk factors for peripartum hysterectomy [1, 16]. Numerous investigations have demonstrated an elevated incidence of hysterectomy in relation to placental diseases and caesarean sections [5,6,7, 9, 10, 15, 17]. Small sample sizes in individual peripartum hysterectomy studies and variations in the definition of the procedure make comparisons challenging [16]. Systematic reviews sometimes omit research done in developing countries [16, 18] or have a disproportionate number of women in impoverished nations [ 1 ]. We used data from a big multinational clinical trial for this investigation, where the majority of the women were from Asia and Africa. This study sought to: i) ascertain the relationship between placenta praevia/accreta and emergency hysterectomy risk; and ii) look into the relationship between emergency hysterectomy risk variables associated to delivery and demographics. Materials and methods Study design: A retrospective cross-sectional study to study the causes, indications and methods of obstetric hysterectomy in a university maternity hospital. Starting from 2016 until 2022. Patients: The study sample included 124 women admitted to the University Obstetrics and Gynecology Hospital who underwent obstetric hysterectomy. Methods: A group of patients admitted to a university maternity hospital was studied according to the following inclusion criteria. All patients who needed a hysterectomy. While the exclusion criteria were as follows: Damaged patient records and records with insufficient information to serve our study. Information was collected according to the research form to determine inclusion and exclusion criteria, During the study period (7 years), the total number of births performed at the university maternity hospital amounted to 84,218 births, 48,783 (57.5)% of whom were born naturally, while 35,435 (42.5)% were born by cesarean section. One hundred and twenty-four women (124) underwent obstetric hysterectomy in seven years, so that the overall incidence rate was 1.47/1000 births. The incidence rate of obstetric hysterectomy among patients undergoing cesarean section was calculated as 3.12/1000 births. The incidence rate was 0.2/1000 births with normal deliveries. The risk factors studied: a history of one or more cesarean births.Age, placental abnormalities (defective attachment of the placenta - placental accretion defects), multiparity, history of uterine curettage, history of fibroid removal, type of birth (cesarean section - natural) Statistical analysis: The data was completed from the forms into an Excel file, and special simple statistics were conducted. The results were summarized and explained with tables and charts. The Spss-28 statistics program was used, and descriptive statistics were reviewed based on percentages and graphical shapes, in addition to measures of central tendency (arithmetic mean and standard deviation). Ethical considerations: Ethical approval was obtained from the Institutional Review Board (IRB), Faculty of Medicine, Al-Sham Private University and the Director of Al-Mowasat University Hospital. Results The incidence of obstetric hysterectomy was highest in 2022, reaching 2.5/1,000 births, accompanied by a noticeable increase in the incidence of caesarean section, reaching 49.6%. While the caesarean section rate reached 32%, with the incidence of hysterectomy reaching 0.8/1000 births in 2016. The number of patients who underwent obstetric hysterectomy and had a natural birth reached 10 patients (8.1%), while (114) 91.9% of the patients in the research sample had a cesarean section. And 24 women (19.35%) of the women who underwent obstetric ablation had only one history of cesarean section, 26 women (20.9)% had two cesarean sections, 24 women (19.3)% had a history of three cesarean sections, and 14 women (11.29%) had a history of four. Caesarean section, 16 women (12.9%) had a history of five or more cesarean sections, knowing that there were 10 women who had a cesarean section for the first time among the women in the research sample. We also find that 80 women (64.5%) had a history of two or more cesarean births, and this indicates that more than half of the women who underwent obstetric ablation had a history of two or more cesarean births, which indicates that a cesarean section increases the incidence of obstetric hysterectomy. We found that only two (1.6)% of the women were less than 20 years old, while we find that 69 (55.6)% of the women were in the age group (30–39), while we find that 26 (20.9)% of the women were 40 years old. and above, and this indicates that age has a role in increasing the incidence of obstetric hysterectomy. And 66.1% (82 women) were very multiparous (they had ≥ 5 births) and only 4 women were primiparous, while we find that 38 women (30.6)% had (1–4) births, and this indicates that the more the number of births, the greater the number of births. The risk of obstetric hysterectomy. And 88.7% (110 women) of the women who underwent obstetric hysterectomy had a history of previous uterine surgery, and this indicates that the presence of a previous scar on the uterus increased the risk of obstetric removal, 40 women (30.25) % had a history of uterine curettage, and 104 (83.8%) women had at least one history of caesarean section. The most common indication for obstetric hysterectomy is placental abnormalities. We find that 68 (54%) women had a defect in placental accretion, and 28 women (22.6%) had a defective attachment of the placenta without insertion of the placenta. Sixty-six women out of 68 women who had a defect. The placenta accreta was accompanied by a defect in the attachment of the placenta, while the placenta was at the bottom of the uterus in only two women, and there were precedents of uterine curettage in their story. In eighteen women (14.5%) of the women who underwent obstetric hysterectomy, the indication was uterine rupture. In ten women (8.1%), it was found that uterine rupture was the main indication for hysterectomy, and there was a history of more than two cesarean deliveries in their history. All women were given uterine constrictors (oxytocin and ergotamine). Other procedures taken prior to hysterectomy were: ligation of the two uterine arteries in 34 women, and ligation of the internal iliac arteries in 10 (8.1)% of women. Hemostasis stitching at the site of placenta in 36 women, uterine perforation in 10 women. It is worth noting that some women received more than one procedure prior to hysterectomy. The most common complication of congenital ablation is damage to the bladder wall. It was found that 20 (16.1%) women suffered damage to the bladder wall, which was diagnosed and sutured properly during the surgical procedure without complications. Two patients (1.6%) of the 124 women who underwent obstetric hysterectomy had ureteral damage, but in all cases in which the ureteral path was isolated during the elective cesarean section in cases of placenta previa, ureteral damage was avoided in cases of hysterectomy, which indicates the necessity of isolating Ureter in elective cesarean section in cases of placenta previa. (22) of the female patients in the research sample were subjected to laparotomy as a late complication. 12 women had their abdomen reopened to control the ongoing bleeding, while 10 women had their abdomen reopened to remove the lesions placed to control the bleeding. There is no statistically significant difference (p > 0.05) between complete and subtotal hysterectomy in terms of the number of blood units transfused, duration of surgery, urinary tract injury, and hospitalization period, and that 76 women (61.2)% underwent total hysterectomy, while 4 women (38.8)% had a subtotal hysterectomy Discussion Placental abnormalities are the most common indication for obstetric hysterectomy. The high rates of cesarean sections, number of births, and history of cesarean sections will inevitably lead to an increase in the rate of obstetric hysterectomy. Obstetric hysterectomy is highly associated with cesarean section, and because of the high risk associated with cesarean section, the decision to perform cesarean section must be made when the benefits outweigh the potential risks. Cancellation of a caesarean section based on the patient’s wishes (caesarean section on request) from obstetric practice. Vaginal delivery should be encouraged following cesarean section. It is necessary to isolate the ureter during caesarean section in cases of inserted placenta before surgery to avoid harming it. Declarations Ethics approval and consent to participate: The Research Ethics Committee at Al-Sham Private University and the ethical committees at the relevant Nawasat University Hospital approved the study protocol, and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or Similar ethical standards. Consent for publication: Not applicable. Availability of data and materials: All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request. Conflict of interest: The authors declare that they have no conflict of interest Funding: This research received no specific grant from ASPU or any other funding agency in the public, commercial or non-profit sectors. Authors’ contributions: M.Y and D.A conceptualized the study, M.Y and D.A wrote the study protocol, performed the statistical analysis, participated in data collection, and did the literature search. M.Y and D.A participated in the literature search, interpret the results, wrote the main manuscript B.A. revised the draft. All authors read and approved the final draft. Acknowledgments: We thank the administration of Al-Sham Private University for their support in the field of medical training and research. And the medical staff at Al-Mouwasat University Hospital. We would also like to thank Dr. Imad al-Din al-Tanukhi for his assistance and supervision of the paper. References van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KW. Prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy worldwide: a systematic review and meta-analysis. Obstet Gynecol. 2016;128(6):1281–94. Article PubMed Google Scholar Pattinson RC, Hall M. Near misses: a useful adjunct to maternal death enquiries. Br Med Bull. 2003;67:231–43. Article PubMed CAS Google Scholar Wright JD, Devine P, Shah M, Gaddipati S, Lewin SN, Simpson LL, et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol. 2010;115(6):1187–93. Article PubMed Google Scholar Sakse A, Weber T, Nickelsen C, Secher NJ. Peripartum hysterectomy in Denmark 1995-2004. Acta Obstet Gynecol Scand. 2007;86(12):1472–5. Article PubMed Google Scholar Campbell SM, Corcoran P, Manning E, Greene RA. Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland. Eur J Obstet Gynecol Reprod Biol. 2016;207:56–61. Article PubMed Google Scholar Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 2008;111(1):97–105. Sahin S, Guzin K, Eroglu M, Kayabasoglu F, Yasartekin MS. Emergency peripartum hysterectomy: our 12-year experience. Arch Gynecol Obstet. 2014;289(5):953–8. Article PubMed Google Scholar Wen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, et al. Severe maternal morbidity in Canada, 1991-2001. CMAJ. 2005;173(7):759–64. Article PubMed PubMed Central Google Scholar Whiteman MK, Kuklina E, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, et al. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol. 2006;108(6):1486–92. Article PubMed Google Scholar Awan N, Bennett MJ, Walters WA. Emergency peripartum hysterectomy: a 10-year review at the Royal Hospital for women, Sydney. Aust N Z J Obstet Gynaecol. 2011;51(3):210–5. Article PubMed Google Scholar Omole-Ohonsi A, Olayinka HT. Emergency peripartum hysterectomy in a developing country. J Obstet Gynaecol Can. 2012;34(10):954–60. Article PubMed Google Scholar Khan B, Khan B, Sultana R, Bashir R, Deeba FA. Ten year review of emergency peripartum hysterectomy in a tertiary care hospital. J Ayub Med Coll Abbottabad. 2012;24(1):14–7. Google Scholar Bateman BT, Mhyre JM, Callaghan WM, Kuklina EV. Peripartum hysterectomy in the United States: nationwide 14 year experience. Am J Obstet Gynecol. 2012;206(1):63.e1–8. Article Google Scholar Yoong W, Massiah N, Oluwu A. Obstetric hysterectomy: changing trends over 20 years in a multiethnic high risk population. Arch Gynecol Obstet. 2006;274(1):37–40. Article PubMed Google Scholar Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol. 2009;114(1):115–23. Article PubMed PubMed Central Google Scholar Additional Declarations The authors declare potential competing interests as follows: no Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3972445","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273847162,"identity":"e02883a0-2fdf-4329-a204-125688c39907","order_by":0,"name":"Mohannad mohammed nazir yasmineh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABHElEQVRIiWNgGAWjYBACgwM8YJqxAUQmABE/mFGAW4slhhZJECvBALcWexQtYMUHwLbj1mJ2vPfg58IddrIbjh9/uuHhDps84/OrEz88MGCQ5xc7gF3LmXPJ0jPPJBtvOJNjdiPxTFqx2Y23myWADjOcOTsBu5YbOQbSvG3MiRsO5LDdSGw7nLjtxtkNIC0JBrexazG4kWP8m7etPnHD+efPgFr+J26ecXbzDwJazIC2HE7ccCMB6LC2A4kb+Hu34bflzBkza96248Yzb7wBaUlOnHGDd5tFgoEETr8YHO8xvs3bVi3bdz792c2fbXaJ/f1nN9/8UWEjzy+NXQscKByAsSTAKiXwKwcB+QYYi/8AblWjYBSMglEwIgEA4sRyKYbNRT8AAAAASUVORK5CYII=","orcid":"","institution":"Faculty of medicine, Al-Sham Private University, Damascus, Syria","correspondingAuthor":true,"prefix":"","firstName":"Mohannad","middleName":"mohammed nazir","lastName":"yasmineh","suffix":""},{"id":273847163,"identity":"1e5fb83d-d5fc-4439-b280-3b05e57ef1b7","order_by":1,"name":"Dalal mohamad emad aldin Alhamwi","email":"","orcid":"","institution":"Faculty of medicine, Al-Sham Private University, Damascus, Syria","correspondingAuthor":false,"prefix":"","firstName":"Dalal","middleName":"mohamad emad aldin","lastName":"Alhamwi","suffix":""},{"id":273847164,"identity":"6d4403b3-52c0-49ef-889c-d826f5478657","order_by":2,"name":"Basel essam albatahesh","email":"","orcid":"","institution":"Faculty of medicine, Al-Sham Private University, Damascus, Syria","correspondingAuthor":false,"prefix":"","firstName":"Basel","middleName":"essam","lastName":"albatahesh","suffix":""}],"badges":[],"createdAt":"2024-02-20 10:08:33","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3972445/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3972445/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51428863,"identity":"d7d73fb3-8879-4b22-8606-d59a52828ca2","added_by":"auto","created_at":"2024-02-21 12:38:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":247203,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3972445/v1/9cd3d6be-c3be-43a7-bf08-544e80eb9a8f.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: no","formattedTitle":"\u003cp\u003e\u003cstrong\u003ePostpartum hysterectomy in the university maternity hospital (a retrospective statistical study)\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA peripartum hysterectomy can be done at any point between giving birth and being released from the hospital. When conservative methods fail to manage significant uterine hemorrhage, peripartum hysterectomy is the recommended course of action [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A \"near-miss\" maternal event is a peripartum hysterectomy, which is an operation done to save a woman's life in a potentially fatal obstetric scenario [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It causes a decline in fertility and is linked to high rates of illness and mortality in mothers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence of peripartum hysterectomy varies greatly across the globe. Peripartum hysterectomy complicates fewer than one delivery out of every 1000 in high-income countries [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], but in Nigeria [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and Pakistan [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the incidence is 4 and 11 per 1000 deliveries, respectively. Over time, there has been an increase in the number of emergency peripartum hysterectomies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It rose by 15% between 1995 and 2007 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and by 12% between 1998 and 2003 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] in the USA.\u003c/p\u003e \u003cp\u003eAdvanced maternal age, aberrant placentation, increased parity, and cesarean delivery in a previous or ongoing pregnancy are risk factors for peripartum hysterectomy [1, 16]. Numerous investigations have demonstrated an elevated incidence of hysterectomy in relation to placental diseases and caesarean sections [5,6,7, 9, 10, 15, 17].\u003c/p\u003e \u003cp\u003eSmall sample sizes in individual peripartum hysterectomy studies and variations in the definition of the procedure make comparisons challenging [16]. Systematic reviews sometimes omit research done in developing countries [16, 18] or have a disproportionate number of women in impoverished nations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. We used data from a big multinational clinical trial for this investigation, where the majority of the women were from Asia and Africa. This study sought to: i) ascertain the relationship between placenta praevia/accreta and emergency hysterectomy risk; and ii) look into the relationship between emergency hysterectomy risk variables associated to delivery and demographics.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design:\u003c/h2\u003e\n \u003cp\u003eA retrospective cross-sectional study to study the causes, indications and methods of obstetric hysterectomy in a university maternity hospital. Starting from 2016 until 2022.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003ePatients:\u003c/h2\u003e\n \u003cp\u003eThe study sample included 124 women admitted to the University Obstetrics and Gynecology Hospital who underwent obstetric hysterectomy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eMethods:\u003c/h2\u003e\n \u003cp\u003eA group of patients admitted to a university maternity hospital was studied according to the following \u003cstrong\u003einclusion criteria.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAll patients who needed a hysterectomy.\u003c/p\u003e\n \u003cp\u003eWhile the \u003cstrong\u003eexclusion criteria\u003c/strong\u003e were as follows:\u003c/p\u003e\n \u003cp\u003eDamaged patient records and records with insufficient information to serve our study.\u003c/p\u003e\n \u003cp\u003eInformation was collected according to the research form to determine inclusion and exclusion criteria, During the study period (7 years), the total number of births performed at the university maternity hospital amounted to 84,218 births, 48,783 (57.5)% of whom were born naturally, while 35,435 (42.5)% were born by cesarean section.\u003c/p\u003e\n \u003cp\u003eOne hundred and twenty-four women (124) underwent obstetric hysterectomy in seven years, so that the overall incidence rate was 1.47/1000 births. The incidence rate of obstetric hysterectomy among patients undergoing cesarean section was calculated as 3.12/1000 births. The incidence rate was 0.2/1000 births with normal deliveries.\u003c/p\u003e\n \u003cp\u003eThe risk factors studied: a history of one or more cesarean births.Age, placental abnormalities (defective attachment of the placenta - placental accretion defects), multiparity, history of uterine curettage, history of fibroid removal, type of birth (cesarean section - natural)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis:\u003c/h2\u003e\n \u003cp\u003eThe data was completed from the forms into an Excel file, and special simple statistics were conducted. The results were summarized and explained with tables and charts. The Spss-28 statistics program was used, and descriptive statistics were reviewed based on percentages and graphical shapes, in addition to measures of central tendency (arithmetic mean and standard deviation).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eEthical considerations:\u003c/h2\u003e\n \u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB), Faculty of Medicine, Al-Sham Private University and the Director of Al-Mowasat University Hospital.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe incidence of obstetric hysterectomy was highest in 2022, reaching 2.5/1,000 births, accompanied by a noticeable increase in the incidence of caesarean section, reaching 49.6%. While the caesarean section rate reached 32%, with the incidence of hysterectomy reaching 0.8/1000 births in 2016.\u003c/p\u003e \u003cp\u003eThe number of patients who underwent obstetric hysterectomy and had a natural birth reached 10 patients (8.1%), while (114) 91.9% of the patients in the research sample had a cesarean section.\u003c/p\u003e \u003cp\u003eAnd 24 women (19.35%) of the women who underwent obstetric ablation had only one history of cesarean section, 26 women (20.9)% had two cesarean sections, 24 women (19.3)% had a history of three cesarean sections, and 14 women (11.29%) had a history of four. Caesarean section, 16 women (12.9%) had a history of five or more cesarean sections, knowing that there were 10 women who had a cesarean section for the first time among the women in the research sample. We also find that 80 women (64.5%) had a history of two or more cesarean births, and this indicates that more than half of the women who underwent obstetric ablation had a history of two or more cesarean births, which indicates that a cesarean section increases the incidence of obstetric hysterectomy.\u003c/p\u003e \u003cp\u003eWe found that only two (1.6)% of the women were less than 20 years old, while we find that 69 (55.6)% of the women were in the age group (30\u0026ndash;39), while we find that 26 (20.9)% of the women were 40 years old. and above, and this indicates that age has a role in increasing the incidence of obstetric hysterectomy.\u003c/p\u003e \u003cp\u003eAnd 66.1% (82 women) were very multiparous (they had\u0026thinsp;\u0026ge;\u0026thinsp;5 births) and only 4 women were primiparous, while we find that 38 women (30.6)% had (1\u0026ndash;4) births, and this indicates that the more the number of births, the greater the number of births. The risk of obstetric hysterectomy.\u003c/p\u003e \u003cp\u003eAnd 88.7% (110 women) of the women who underwent obstetric hysterectomy had a history of previous uterine surgery, and this indicates that the presence of a previous scar on the uterus increased the risk of obstetric removal, 40 women (30.25) % had a history of uterine curettage, and 104 (83.8%) women had at least one history of caesarean section.\u003c/p\u003e \u003cp\u003eThe most common indication for obstetric hysterectomy is placental abnormalities. We find that 68 (54%) women had a defect in placental accretion, and 28 women (22.6%) had a defective attachment of the placenta without insertion of the placenta. Sixty-six women out of 68 women who had a defect. The placenta accreta was accompanied by a defect in the attachment of the placenta, while the placenta was at the bottom of the uterus in only two women, and there were precedents of uterine curettage in their story. In eighteen women (14.5%) of the women who underwent obstetric hysterectomy, the indication was uterine rupture. In ten women (8.1%), it was found that uterine rupture was the main indication for hysterectomy, and there was a history of more than two cesarean deliveries in their history.\u003c/p\u003e \u003cp\u003eAll women were given uterine constrictors (oxytocin and ergotamine). Other procedures taken prior to hysterectomy were: ligation of the two uterine arteries in 34 women, and ligation of the internal iliac arteries in 10 (8.1)% of women. Hemostasis stitching at the site of placenta in 36 women, uterine perforation in 10 women. It is worth noting that some women received more than one procedure prior to hysterectomy.\u003c/p\u003e \u003cp\u003eThe most common complication of congenital ablation is damage to the bladder wall. It was found that 20 (16.1%) women suffered damage to the bladder wall, which was diagnosed and sutured properly during the surgical procedure without complications.\u003c/p\u003e \u003cp\u003eTwo patients (1.6%) of the 124 women who underwent obstetric hysterectomy had ureteral damage, but in all cases in which the ureteral path was isolated during the elective cesarean section in cases of placenta previa, ureteral damage was avoided in cases of hysterectomy, which indicates the necessity of isolating Ureter in elective cesarean section in cases of placenta previa.\u003c/p\u003e \u003cp\u003e(22) of the female patients in the research sample were subjected to laparotomy as a late complication. 12 women had their abdomen reopened to control the ongoing bleeding, while 10 women had their abdomen reopened to remove the lesions placed to control the bleeding.\u003c/p\u003e \u003cp\u003eThere is no statistically significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between complete and subtotal hysterectomy in terms of the number of blood units transfused, duration of surgery, urinary tract injury, and hospitalization period, and that 76 women (61.2)% underwent total hysterectomy, while 4 women (38.8)% had a subtotal hysterectomy\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePlacental abnormalities are the most common indication for obstetric hysterectomy.\u003c/p\u003e \u003cp\u003eThe high rates of cesarean sections, number of births, and history of cesarean sections will inevitably lead to an increase in the rate of obstetric hysterectomy.\u003c/p\u003e \u003cp\u003eObstetric hysterectomy is highly associated with cesarean section, and because of the high risk associated with cesarean section, the decision to perform cesarean section must be made when the benefits outweigh the potential risks.\u003c/p\u003e \u003cp\u003eCancellation of a caesarean section based on the patient\u0026rsquo;s wishes (caesarean section on request) from obstetric practice.\u003c/p\u003e \u003cp\u003eVaginal delivery should be encouraged following cesarean section.\u003c/p\u003e \u003cp\u003eIt is necessary to isolate the ureter during caesarean section in cases of inserted placenta before surgery to avoid harming it.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee at Al-Sham Private University and the ethical committees at the relevant Nawasat University Hospital approved the study protocol, and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or Similar ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data related to this paper\u0026rsquo;s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from ASPU or any other funding agency in the public, commercial or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.Y and D.A conceptualized the study, M.Y and D.A wrote the study protocol, performed the statistical analysis, participated in data collection, and did the literature search. M.Y and D.A participated in the literature search, interpret the results, wrote the main manuscript B.A. revised the draft. All authors read and approved the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the administration of Al-Sham Private University for their support in the field of medical training and research. And the medical staff at Al-Mouwasat University Hospital. We would also like to thank Dr. Imad al-Din al-Tanukhi for his assistance and supervision of the paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003evan den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KW. Prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy worldwide: a systematic review and meta-analysis. Obstet Gynecol. 2016;128(6):1281\u0026ndash;94. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003ePattinson RC, Hall M. Near misses: a useful adjunct to maternal death enquiries. Br Med Bull. 2003;67:231\u0026ndash;43. Article PubMed CAS Google Scholar\u003c/li\u003e\n\u003cli\u003eWright JD, Devine P, Shah M, Gaddipati S, Lewin SN, Simpson LL, et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol. 2010;115(6):1187\u0026ndash;93. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eSakse A, Weber T, Nickelsen C, Secher NJ. Peripartum hysterectomy in Denmark 1995-2004. Acta Obstet Gynecol Scand. 2007;86(12):1472\u0026ndash;5. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eCampbell SM, Corcoran P, Manning E, Greene RA. Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland. Eur J Obstet Gynecol Reprod Biol. 2016;207:56\u0026ndash;61. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eKnight M, Kurinczuk JJ, Spark P, Brocklehurst P. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 2008;111(1):97\u0026ndash;105.\u003c/li\u003e\n\u003cli\u003eSahin S, Guzin K, Eroglu M, Kayabasoglu F, Yasartekin MS. Emergency peripartum hysterectomy: our 12-year experience. Arch Gynecol Obstet. 2014;289(5):953\u0026ndash;8. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eWen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, et al. Severe maternal morbidity in Canada, 1991-2001. CMAJ. 2005;173(7):759\u0026ndash;64. Article PubMed PubMed Central Google Scholar\u003c/li\u003e\n\u003cli\u003eWhiteman MK, Kuklina E, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, et al. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol. 2006;108(6):1486\u0026ndash;92. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eAwan N, Bennett MJ, Walters WA. Emergency peripartum hysterectomy: a 10-year review at the Royal Hospital for women, Sydney. Aust N Z J Obstet Gynaecol. 2011;51(3):210\u0026ndash;5. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eOmole-Ohonsi A, Olayinka HT. Emergency peripartum hysterectomy in a developing country. J Obstet Gynaecol Can. 2012;34(10):954\u0026ndash;60. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eKhan B, Khan B, Sultana R, Bashir R, Deeba FA. Ten year review of emergency peripartum hysterectomy in a tertiary care hospital. J Ayub Med Coll Abbottabad. 2012;24(1):14\u0026ndash;7. Google Scholar\u003c/li\u003e\n\u003cli\u003eBateman BT, Mhyre JM, Callaghan WM, Kuklina EV. Peripartum hysterectomy in the United States: nationwide 14 year experience. Am J Obstet Gynecol. 2012;206(1):63.e1\u0026ndash;8. Article Google Scholar\u003c/li\u003e\n\u003cli\u003eYoong W, Massiah N, Oluwu A. Obstetric hysterectomy: changing trends over 20 years in a multiethnic high risk population. Arch Gynecol Obstet. 2006;274(1):37\u0026ndash;40. Article PubMed Google Scholar\u003c/li\u003e\n\u003cli\u003eBodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol. 2009;114(1):115\u0026ndash;23. Article PubMed PubMed Central Google Scholar\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"5ff7b300-0435-4fbf-8c75-a42a515d0211","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0996066591","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Sham Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"postpartum hysterectomy, university maternity hospital, retrospective cohort study","lastPublishedDoi":"10.21203/rs.3.rs-3972445/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3972445/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo study the file of patients who underwent obstetric hysterectomy and learn the indications, risk factors, and complications to reduce its occurrence as much as possible.\u003c/p\u003e\u003ch2\u003eType of study:\u003c/h2\u003e \u003cp\u003eretrospective cohort study\u003c/p\u003e\u003ch2\u003ePlace of study:\u003c/h2\u003e \u003cp\u003eObstetrics and Gynecology University Hospital in Damascus - Records of the Archives Division.\u003c/p\u003e\u003ch2\u003eStudy period:\u003c/h2\u003e \u003cp\u003estarting from 1/1/2016 until 12/31/2022.\u003c/p\u003e\u003ch2\u003ePatients:\u003c/h2\u003e \u003cp\u003eThe study sample included 124 women admitted to the University Obstetrics and Gynecology Hospital who underwent obstetric hysterectomy.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e91.9.9% of the patients had a natural birth, while 8.1% had a cesarean section. The rate of performing a total hysterectomy was 1.47/1000, within seven years. The rate of it being performed among patients with a cesarean section was 3.12/1000, and the rate of it being performed among patients with a natural birth was 0.2/1000. The most common indication for a postpartum hysterectomy is placenta accreta (54%), and the most common complication of obstetric hysterectomy is urinary tract injury (22%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCongenital hysterectomy is highly associated with cesarean section, and because of the high risk associated with cesarean section, the decision to perform cesarean section should be made when its benefits outweigh the potential risks.\u003c/p\u003e","manuscriptTitle":"Postpartum hysterectomy in the university maternity hospital (a retrospective statistical study)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-21 12:30:19","doi":"10.21203/rs.3.rs-3972445/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63235236-d67e-4699-b820-9ad5093b9e06","owner":[],"postedDate":"February 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28860565,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2024-02-21T12:30:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-21 12:30:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3972445","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3972445","identity":"rs-3972445","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}