title: Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More?
abstract: Introduction. To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy). Methods. We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center. We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique. Results. AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919). Of the 18, 14 (78%) had a prior cesarean section (CS) history and the other 4 (22%) were primiparous women. Planned AIP-hysterectomy was performed in 12/18 (67%), with the remaining 6 (33%) undergoing emergent AIP-hysterectomy. Of the 6, 4 (4/6: 67%) patients were primiparous women. An intra-arterial balloon was inserted in 9/18 (50%). Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon (4,448 ± 1,948 versus 8,861 ± 3,988 mL), planned hysterectomy (5,003 ± 2,057 versus 9,957 ± 4,485 mL), and prior CS (5,706 ± 2,727 versus 9,975 ± 5,532 mL). Patients with prior CS (-) bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation. Conclusion. Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy. Massive bleeding occurred in emergent AIP-hysterectomy without prior CS.
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Hironori
authors.identifier: 0000-0003-1652-9438
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Akihide
authors.identifier: 0000-0002-8861-1572
authors.initials: A
authors.lastname: Ohkuchi
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Usui
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Hirotada
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Baba
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Shigeki
authors.identifier: 0000-0003-4378-221X
authors.initials: S
authors.lastname: Matsubara