Long‐term morbidity of peripartum hysterectomy: A systematic review
Notice bibliographique
Résumé
BACKGROUND: Surgical removal of the uterus during pregnancy or immediately post-partum is called peripartum hysterectomy. It can be pre-planned as an elective or performed as an emergency life-saving procedure for severe hemorrhage. Although rare, it is a catastrophic event leading to severe maternal morbidity and a prolonged recovery period. Besides the well-documented acute and subacute sequelae, perpartum hysterectomy may produce long-lasting physical, social, and psychological impacts. OBJECTIVES: Long-term complications of peripartum hysterectomy have barely been explored or recognized. The scattered information gathered from studies involving different corners of the world has yet to be synthesized or organized into coherent clusters of evidence. Therefore, the current study aims to fill the research gap by synthesizing the best available evidence, triggering the adoption of better management strategies. SEARCH STRATEGY: We searched the Embase, PubMed, Science Direct, and Cochrane Library databases. Study selection was conducted using the semi-automated tool Rayyan. SELECTION CRITERIA: Full-text articles published up to April 22, 2024 on randomized controlled trials, qualitative studies, cohort studies, case-control studies, cross-sectional studies, and case reports in the English language reporting long-term complications of peripartum hysterectomy were included, while review articles, book chapters, and studies reporting poor neonatal outcomes were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted under three broad themes: long-term quality of life, psychological outcomes, and women's experiences. Data synthesis involved a thematic analysis. Study quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) tools. Meta-analysis was not performed due to the qualitative nature of the evidence and the heterogeneity of study outcomes. MAIN RESULTS: There were no randomized controlled trials. Eighteen studies were analyzed (eight cohorts, one case-control, one case report, one cross-sectional, and seven qualitative) with 503 peripartum hysterectomy women. Overall, all the included studies showed solid methodological quality. Peripartum hysterectomy led to profound psychological impacts, including post-traumatic stress disorder (PTSD), depression, anxiety, and grief, with a fluctuating course over several months to decades. Peripartum hysterectomy significantly impaired quality of life, with declines in physical functioning, social functioning, and general mental health domains, which lasted several months to a few years. Self-narrations of women revealed breastfeeding issues, delayed emotional reactions, poor bonding with the infant, feelings of maternal failure, regrets for the loss of fertility, ongoing traumatic memories, persistent pain, dyspareunia, marital insecurity, and lack of family support, with some issues haunting them even decades later. CONCLUSIONS: Traditional puerperium follow-up schedules do not meet the needs of women recovering from peripartum hysterectomy. The present study provides insights into the long-term physical, psychological, and social consequences of peripartum hysterectomy, prompting healthcare professionals to look for those actively. It may lead to early recognition of the complications, resulting in better patient-centered care and improved quality of life. Further, well-designed studies are warranted to raise awareness, plan appropriate interventions, and introduce follow-up guidelines.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,039 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,007 | 0,006 |
| Bibliométrie | 0,011 | 0,014 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».