Objectives To assess the prevalence of major obstetric haemorrhage managed with peripartum hysterectomy and/or interventional radiology (IR) in Belgium. To describe women characteristics, the circumstances in which the interventions took place, the management of the obstetric haemorrhage, the outcome and additional morbidity of these women.
Design Nationwide population-based prospective cohort study.
Setting Emergency obstetric care. Participation of 97% of maternities covering 98.6% of deliveries in Belgium.
Participants All women who underwent peripartum hysterectomy and/or IR procedures in Belgium between January 2012 and December 2013.
Results We obtained data on 166 women who underwent peripartum hysterectomy (n=84) and/or IR procedures (n=102), corresponding to 1 in 3030 women undergoing a peripartum hysterectomy and another 1 in 3030 women being managed by IR, thereby preserving the uterus. Seventeen women underwent hysterectomy following IR and three women needed further IR despite hysterectomy. Abnormal placentation and/or uterine atony were the reported causes of haemorrhage in 83.7%. Abnormally invasive placenta was not detected antenatally in 34% of cases. The interventions were planned in 15 women. Three women were transferred antenatally and 17 women postnatally to a hospital with emergency IR service. Urgent peripartum hysterectomy was averted in 72% of the women who were transferred, with no significant difference in need for transfusion. IR procedures were able to stop the bleeding in 87.8% of the attempts. Disseminated intravascular coagulation secondary to major haemorrhage was reported in 32 women (19%).
Conclusion The prevalence in Belgium of major obstetric haemorrhage requiring peripartum hysterectomy and/or IR is estimated at 6.6 (95% CI 5.7 to 7.7) per 10 000 deliveries. Increased clinician awareness of the risk factors of abnormal placentation could further improve the management and outcome of major obstetric haemorrhage. A case-by-case in-depth analysis is necessary to reveal whether the hysterectomies and arterial embolisations performed in this study were appropriate or preventable.
- peripartum hysterectomy
- arterial embolisation
- interventional radiology
- major obstetrichaemorrhage
- maternal near miss
- severe maternal morbidity
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Contributors Project conception: MH, YE. Study design: GV, VVL, JV, MH, YE. Data collection: GV, MG, IR, VVL, JV. Data analysis: GV, MG, IJ, ER. Data interpretation: GV, MG, IJ, KR, MH, ER, YE, HV. Manuscript first draft: GV. Contributed to the writing of the manuscript: MG, IJ, KR, MH, YE, HV. Manuscript revision: MG, IJ, VVL, KR, MH, ER, JV, YE, HV. All authors approved the final version, agreed to be accountable for all aspects of the work and met the ICMJE criteria for authorship.
Funding The study was funded by the College for Mother and Newborn, a consultative body of the Belgian Public Health Service. GV was funded by the Flemish Research Foundation (FWO).
Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and hereby declare that they have no financial relationships with any organisations that might have an interest in the submitted work in the past 3 years, nor that they have partaken of any other relationships or activities that could appear to have influenced the submitted work.
Patient consent Data were retrieved in retrospect from the case notes by means of data collection forms. No personally identifiable information was obtained. Participants were informed and enabled to opt-out.
Ethics approval Medical Ethics Committee of the Ghent University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no additional unplished data from the study available.
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