Emergency Obstetric Hysterectomies (How Many Are Potentially Preventable?): A 28-Year Experience in Saskatoon
Bibliographic record
Abstract
Objective: We sought to determine the frequency, contributory factors, and morbidity of emergency obstetric hysterectomy (EOH) in our obstetric population, and suggest means for preventing this drastic surgical intervention. Methods: This was a retrospective review of the records of patients who had EOH during a 28-year period (1965–1993) at the Royal University Hospital, Saskatoon. We analyzed the patients' histories, operative reports, postoperative care, and perinatal outcomes. Results: There were 56 cases of EOH among a total of 30290 deliveries, representing an incidence of 1 in 541 deliveries (1.9 per 1000 deliveries). The mean age of the patients was 29.5 years. The surgical method applied in 50 cases (89.3%) was total hysterectomy while six (10.7%) had subtotal hysterectomy. Uterine atony was the leading indication for EOH (48.2%), followed by placenta accreta (26.8%), uterine rupture (10.7%), chorioamnionitis (10.7%), and extension of the lower uterine segment cesarean incision (3.6%). Hysterectomies performed for uterine atony was associated with grand multiparity (p < 0.0072), previous cesarean section (p < 0.5), chorioamnionitis (p < 0.26), previous postpartum hemorrhage (p < 0.08), oxytocin augmentation (p < 0.005), mean birthweight (p < 0.22), and tocolytic administration (p < 0.36). P values < 0.05 were considered significant. There was an associated high maternal morbidity: febrile morbidity, 55%; ureteric injuries, 41%; blood transfusion, 36%; pulmonary atelectasis, 32%; wound infection, 30%; psychological disturbance, 23%; and pelvic abscess, 16%, although maternal and perinatal mortalities were low (1.8%) and 6%, respectively). Conclusions: Uterine atony is a significant risk factor for EOH. Two-thirds of EOHs might have been prevented if adequate uterine contractility had been achieved at cesarean section or vaginal delivery. It should be stated clearly that prompt performance of obstetric hysterectomy before the patient's clinical condition deteriorates is the main key to success. Reduction of the frequency of uterine atony is achievable with the use of newer prostaglandin uterotonics. These agents may contribute to a reduction in the incidence of EOH. (J GYNECOL SURG 20:81)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".