Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Perimortem caesarean section (PCS) is a rare event often resulting in high mortality of mother and/or fetus. It represents a tragedy for the mother and the family and a crisis for the healthcare professionals managing such a case. This paper seeks to raise awareness of the pertinent issues surrounding PCS and challenges care providers to put in place procedures to deal with this catastrophic event. It also reviews the historical perspective of PCS, maternal physiology during cardiopulmonary resuscitation (CPR), prognostic factors for maternal and fetal wellbeing, techniques of PCS, survival for mother and baby and the medico legal aspects of PCS.
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This was a retrospective review of all cases of peripartum obstetric hysterectomy performed at the Istanbul Bakirkoy Women and Children's Teaching Hospital in the period between January 2001 and September 2008. We included any women who required emergency hysterectomy to control major postpartum haemorrhage after delivery. During the study period, there were 91 cases of peripartum hysterectomy. ⋯ The main indication for emergency hysterectomy was uterine atony in 52 cases (57.1%). The most independent risk factors for emergency hysterectomy were multiparity (odds ratios (OR) 17.3, 95% confidence interval (95% CI) 8.7-34.6); caesarean delivery in index delivery (OR 6.7, 95% CI 3.8-11.9) and caesarean section for placental abruption (OR 3.8, 95% CI 0.4-33.4). Our study suggests that multiparity, primary or repeat caesarean deliveries for placental abruption are independently associated risks for peripartum hysterectomy and uterine atony is the still most common indication for peripartum hysterectomy in Turkey.
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This study describes cases of fibroids with venous thromboembolism (VTE) managed at UHWI between the years 1999-2004. We examined records to find patients with fibroids and VTE diagnosed before or after surgery. We found 438 women with VTE and 72 of these (16.4%) with fibroids. ⋯ Most cases 67/72 (93%) had VTE without surgery. Of the five cases with VTE after surgery for fibroids, none had prophylactic heparin. Of the cases, 15 died--23% of women with VTE at PM and 0.8% of those with fibroids.