Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage

Knight, M; UKOSS

doi:10.1111/j.1471-0528.2007.01507.x

Cited by 336Maternal and fetal healthcareBlood transfusion and managementUterine Myomas and Treatments

Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage

Knight, M, UKOSS·2007·BJOG: An International Journal of Obstetrics & Gynaecology

DOI 10.1111/j.1471-0528.2007.01507.x

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Abstract

Objectives To identify women undergoing peripartum hysterectomy in the UK and to describe the causes, management and outcome of the associated haemorrhage. Design A population‐based descriptive study using the UK Obstetric Surveillance System (UKOSS). Setting All 229 hospitals with consultant‐led maternity units in the UK. Population All women in the UK delivering between February 2005 and February 2006. Methods Prospective case identification through the UKOSS monthly mailing. Main outcome measures Rates with 95% CIs. Odds ratio estimates. Results Three hundred and eighteen women underwent peripartum hysterectomy. The most commonly reported causes of haemorrhage were uterine atony (53%) and morbidly adherent placenta (39%). Women were not universally managed with uterotonic therapies. Fifty women were unsuccessfully managed with B‐Lynch or other brace suture prior to hysterectomy, 28 with activated factor VII and 9 with arterial embolisation. Twenty‐one percent of women suffered damage to other structures, 20% required a further operation and 19% were reported to have additional severe morbidity. Bladder damage was more likely in women with placenta accreta (OR 3.41, 95% CI 1.55–7.48) than in women with uterine atony. There were no significant differences in outcomes between women undergoing total or subtotal hysterectomy. Two women died; case fatality 0.6% (95% CI 0–1.5%). Conclusions For each woman who dies in the UK following peripartum hysterectomy, more than 150 survive. The associated haemorrhage is managed in a variety of ways and not universally according to existing guidelines. Further investigation of the outcomes following some of the more innovative therapies for control of haemorrhage is needed.

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Caesarean hysterectomy has been shown to be a life-saving treatment for women where other uterus-conserving surgeries fail.
“Previous studies have shown caesarean hysterectomy to be a life‐saving treatment for women where other uterus‐conserving surgeries fail.”
From Placenta accreta spectrum – variations in clinical practice and maternal morbidity between the <scp>UK</scp> and France: a population‐based comparative study (2022) · cites this paper as [20]

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Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries
Kallianidis, A. F., Maraschini, A., Danis, J., Colmorn, L. B., Deneux‐Tharaux, C., Donati, S., Gissler, M., Jakobsson, M., Knight, M., Krištúfková, A., et al. (2021) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14113 · Cited by 14 · see citing works
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Authors: Knight, M., & UKOSS
Affiliations: University of Oxford (GB)
Corresponding author: Knight, M
ORCID: Knight, M
Venue: BJOG: An International Journal of Obstetrics & Gynaecology
Publisher: Wiley
Published: 2007-09-18
Volume: 114
Issue: 11
Pages: 1380-1387
ISSN: 0306-5456 (ISSN-L)
1470-0328
1471-0528
DOI: 10.1111/j.1471-0528.2007.01507.x
OpenAlex: W2044391056
Cited by: 336
References: 17
Citations by year: 2026: 8 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 18 · 2021: 13 · 2020: 11 · 2019: 25 · 2018: 16 · 2017: 15 · 2016: 21 · 2015: 26 · 2014: 20 · 2013: 22 · 2012: 21
FWCI: 22.03
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
PubMed (publishedVersion)
Funders: Obstetric Anaesthetists' Association
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Health Sciences › Medicine › Biochemistry › Blood transfusion and management
Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Keywords: peripartum hysterectomy, postpartum hemorrhage, uterine atony, placenta accreta, placenta accreta spectrum, B-Lynch suture, arterial embolization, factor VIIa, bladder injury, hysterectomy outcomes, case fatality, obstetric monitoring
MeSH terms: Adult, Blood Transfusion, Female, United Kingdom, Postpartum Hemorrhage, Humans, Hysterectomy, Length of Stay, Placenta Diseases, Postoperative Care, Pregnancy, Prognosis, Prospective Studies, Reoperation, Risk Factors, Uterine Inertia, Odds Ratio

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Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage

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