title: Emergency hysterectomy for life-threatening postpartum haemorrhage: Risk factors and psychological impact.
abstract: BACKGROUND
  Emergency postpartum hysterectomy (EPH) is usually considered the final resort for the management of postpartum hemorrhage (PPH). The aim of this observational study was to identify the risk factors for EPH, to evaluate the ability of EPH to stop bleeding and, finally, to estimate its psychological impact.
  
  
  METHODS
  This was a retrospective analysis of postpartum hysterectomy in all patients with PPH admitted between 2004 and 2011 to Lariboisière Hospital. We compared women for whom EPH was successful and those who required an advanced interventional procedure (AIP) to stop the bleeding despite hysterectomy. We also evaluated the severe PPH (SPPH) score in this particular setting. The psychological impact of emergency hysterectomy was also assessed.
  
  
  RESULTS
  A total of 44 hysterectomies were performed among 869 cases of PPH. Twenty were successful, while an additional AIP was required in 22 others (50%). Prothrombin time<50% and a shorter interval between the onset of PPH and hysterectomy were independently associated with the need for an additional AIP. The area under the ROC curve of the SPPH score to predict the need for another AIP was 0.738 (95% confidence interval 0.548-0.748). Furthermore, 64% of the hysterectomized patients suffered from post-traumatic stress disorder.
  
  
  CONCLUSIONS
  Failure of postpartum hysterectomy to control bleeding was frequent, and it was associated with persistence of coagulopathy. Hysterectomy in this context had important psychological impacts.
authors.affiliation: Department of Anesthesiology, Robert-Debré University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; University Paris Diderot, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Michelet
authors.affiliation: University Paris Diderot, Paris, France; Department of Obstetrics and Gynecology, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Ricbourg
authors.affiliation: Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Gosme
authors.affiliation: University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Rossignol
authors.affiliation: University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Schurando
authors.affiliation: University Paris Diderot, Paris, France; Department of Obstetrics and Gynecology, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Barranger
authors.affiliation: University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; UMR-S 942, Inserm, 75010 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: University Paris Diderot, Paris, France; Department of Anesthesiology and Intensive Care, Saint-Louis-Lariboisière University Hospital, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; UMR-S 942, Inserm, 75010 Paris, France. Electronic address: etienne.gayat@lrb.aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Gayat
mesh_terms: D000328:Adult; D004638:Emergency Treatment / Q000523:psychology*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D006473:Postpartum Hemorrhage / Q000523:psychology / Q000601:surgery*; D011247:Pregnancy; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Hysterectomy; Hystérectomie; Hémorragie du post-partum; Post-traumatic stress disorder; Postpartum haemorrhage; Syndrome de stress post-traumatique