Our Summary

This study looked at the details and outcomes of emergency and planned hysterectomies (surgical removal of the uterus) performed around the time of childbirth at a hospital in Malaysia from 2016 to 2021. Out of over 100,000 deliveries, 65 resulted in a hysterectomy. Most of these women had given birth before, had a previous cesarean scar, or were diagnosed with a condition where the placenta covers the cervix.

The study divided the cases into two groups: emergency hysterectomies (EH) and planned hysterectomies (PH). The main reason for planned hysterectomies was abnormal placenta location, while the most common reason for emergency surgeries was heavy bleeding after childbirth due to abnormal placenta.

The study found that women who underwent emergency hysterectomies were more likely to lose a lot of blood, need to be admitted to the ICU, require blood transfusions, and have a lower level of hemoglobin (a protein that carries oxygen in the blood) after surgery. However, there was no significant difference in the amount of blood transfused, operation time, length of hospital stay, baby’s weight, or baby’s health score between the two groups.

Interestingly, the amount of blood loss decreased significantly in the second half of the study period. Emergency hysterectomies due to non-placental causes required more blood transfusions than those due to placental causes.

The study also noted more cases of post-surgery fever and the need for additional surgery in the emergency group, while injuries to the bladder and ureter occurred only in the planned group.

In conclusion, most hysterectomies around childbirth are due to problems with placenta attachment. Planned surgeries have fewer complications than emergency ones, so early identification of these placenta disorders and timely planning for surgery are important to reduce the need for emergency procedures.

FAQs

  1. What were the main reasons for planned and emergency hysterectomies around childbirth?
  2. What were the major differences in outcomes between emergency and planned hysterectomies?
  3. What was the significance of placenta disorders in relation to hysterectomies performed around childbirth?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is to discuss any concerns or questions they have with their healthcare provider. It’s important for patients to understand the reasons for the surgery, the risks and benefits, and what to expect during and after the procedure. Patients should also follow their doctor’s instructions for pre-operative and post-operative care to ensure a smooth recovery. Additionally, patients should be aware of any warning signs of complications, such as heavy bleeding, infection, or severe pain, and seek medical attention if they experience any of these symptoms.

Suitable For

Overall, patients who are typically recommended hysterectomy around the time of childbirth are those who have a history of previous cesarean sections, placenta previa (placenta covering the cervix), abnormal placenta location, and heavy bleeding after childbirth. These patients may require emergency hysterectomy if complications arise during childbirth. Planned hysterectomies are usually recommended for cases where placenta disorders are identified early, in order to prevent emergency situations and reduce complications. Early identification and timely planning for surgery are crucial in managing these cases effectively and ensuring the best outcomes for both the mother and baby.

Timeline

Overall, the timeline of a patient’s experience before and after hysterectomy around childbirth includes:

Before hysterectomy:

  • Pregnancy with risk factors such as previous cesarean scar or placenta previa
  • Diagnosis of placenta-related complications necessitating hysterectomy
  • Decision-making process with healthcare providers regarding planned or emergency surgery

During hysterectomy:

  • Emergency or planned surgery based on the severity of the placental issues
  • Potential complications such as heavy bleeding, need for blood transfusions, ICU admission, and lower hemoglobin levels
  • Surgical procedure to remove the uterus and potentially other organs if necessary

After hysterectomy:

  • Recovery period in the hospital with monitoring for post-surgery complications such as fever or additional surgery
  • Potential need for blood transfusions or other medical interventions
  • Follow-up care and monitoring for long-term health outcomes

Overall, early identification and timely intervention for placenta-related complications are crucial to improving outcomes and reducing the need for emergency hysterectomies during childbirth.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hysterectomy include:

  1. What are the reasons for recommending a hysterectomy in my case?
  2. What are the risks and benefits of undergoing a hysterectomy?
  3. Are there any alternative treatment options available?
  4. What type of hysterectomy procedure will be performed (e.g. abdominal, vaginal, laparoscopic)?
  5. What is the expected recovery time after the surgery?
  6. Will I experience any long-term effects or complications from the hysterectomy?
  7. How will a hysterectomy affect my hormone levels and menopause symptoms?
  8. Will I still be able to have children after a hysterectomy?
  9. How often will I need to follow up with my doctor after the surgery?
  10. Are there any lifestyle changes or precautions I should take before or after the procedure?

Reference

Authors: Nor AM, Jagdeesh K, Mohd FAS, Kamraul AK, Yusmadi A, Noraslawati R, Malina O, Roziana R. Journal: Med J Malaysia. 2023 Nov;78(6):756-762. PMID: 38031217