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Byun, Kim, Jeong, Seo, Jeong, Kang, Sung, Lee, and Kim: Prognosis and indication of emergency hysterectomy following postpartum hemorrhage
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(12): 901-906.

Published online: 18 December 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.12.901

Prognosis and indication of emergency hysterectomy following postpartum hemorrhage

Jung Mi Byun, MD1, Young Nam Kim, MD1, 2, Dae Hoon Jeong, MD1, 2, Young Jin Seo, MD1, Eun Jeong Jeong, MD1, Ji Young Kang, MD3, Moon Su Sung, MD1, Kyung Bok Lee, MD1, Ki Tae Kim, MD1, 2

1Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

2Paik Institute for Clinical Research, Inje University, Busan, Korea.

3Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan, Korea.

Corresponding author: Ki Tae Kim, MD. Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. Tel: +82-51-890-6374 Fax: +82-51-897-6380, hellojungmi@hanmail.net

Received 10 July 2012       Revised 12 October 2012       Accepted 14 October 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To compare the clinical characteristics and the prognosis between emergency hysterectomy and conservative treatment following postpartum hemorrhage.

Methods

Primary postpartum hemorrhage was identified in 68 patients who treated in our hospital after delivery at Inje University Busan Paik Hospital and local hospital between 2004 and 2011. 29 patients of these were performed emergency hysterectomy and 39 patients conserved uterus. Clinical characteristics and prognosis of postpartum hemorrhage were reviewed and analyzed with medical records.

Results

There were no difference of mean age, body mass index, parity, causes of postpartum hemorrhage (PPH), and labor induction between hysterectomy and conservative treatment. The hysterectomy patients had lower blood pressure (83.62/48.01 mm Hg ± 19.16/21.68 mm Hg vs. 96.10/64.12 mm Hg ±16.17/22.8 mm Hg), higher heart rate (114 ± 21.68/min vs. 96.10 ± 22.8/min), and lower hemoglobin concentration (6.99 ± 3.06 g/dL vs. 8.34 ± 2.1 g/dL) than the patients with conservative treatment (P=0.0007, 0.0017, 0.0358, respectively). Hysterectomy group had a longer hospital stay, much more management in intensive care unit (ICU) and more complications than conservative group (P=0.0004, <0.0001, 0.0049, respectively).

Conclusion

If patients with postpartum hemorrhage were hemodynamically unstable, it is more possible to be performed the emergency hysterectomy. Emergency hysterectomy was associated with a longer hospital stay and more complications. Therefore we consider that early recognition of PPH with frequent monitoring of vital sign, uterine contraction and vaginal bleeding is able to reduce unnecessary hysterectomy and minimize potentially serious outcomes.

Keywords: Postpartum hemorrhage, Hysterectomy, Conservative treatment

Figures and Tables

Table 1
The cause of postpartum hemorrhage (n = 93)
kjog-55-901-i001

DIC, disseminated intravascular coagulation.

Table 2
The characteristics of the patients (n = 68: except the patients with previous hysterectomy)
kjog-55-901-i002

Values are presented as mean ± standard deviation or number (%).

BMI, body mass index; HR, heart rate; BP, blood pressure; Hb, hemoglobin.

Table 3
The comparison of prognosis after hysterectomy and conservative management
kjog-55-901-i003

Values are presented as mean ± standard deviation or number (%).

ICU, intensive care unit; DIC, disseminated intravascular coagulation.

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