Objective To determine incidence, risk indicators, and outcomes of emergency peripartum hysterectomy (EPH) in Metro East, Cape Town, South Africa. Methods A population-based district-wide... Show moreObjective To determine incidence, risk indicators, and outcomes of emergency peripartum hysterectomy (EPH) in Metro East, Cape Town, South Africa. Methods A population-based district-wide prospective descriptive study of EPH in public hospitals from November 2014 to November 2015. Women were enrolled by using the WHO maternal near miss tool and followed until discharge. EPH was defined as hemorrhage or infection leading to hysterectomy during pregnancy or within 42 days of delivery. Results Fifty-nine women experienced EPH with an overall incidence of 14.3 per 10 000 women: 32 procedures were for postpartum hemorrhage, 27 for puerperal sepsis. Two women died: one from sepsis; one from hemorrhage. Overall, 51 (86%) women delivered by cesarean, and 23/51 (45%) by repeat cesarean. As compared with hemorrhage, EPH for sepsis involved older women (mean age, 31.5 vs 24.4 years) and those with higher gravidity (median, 3 vs 1), and was associated with longer hospital admission (median, 11.5 vs 4 days), with occurrence later postpartum (median, 8 vs 0 days), and more frequently with complications. Conclusions The incidence of EPH for sepsis was higher than previously reported. Repeat cesarean was strongly associated with EPH. Clinical characteristics of sepsis-related EPH compared unfavorably with those of hemorrhage-related EPH. Show less
Tura, A.K.; Stekelenburg, J.; Scherjon, S.A.; Zwart, J.; Akker, T. van den; Roosmalen, J. van; Gordijn, S.J. 2017
Using the results from a two-year nationwide prospective study, this thesis shows numerous (risk) factors associated with severe acute maternal morbidity (SAMM) in the Netherlands and validates... Show moreUsing the results from a two-year nationwide prospective study, this thesis shows numerous (risk) factors associated with severe acute maternal morbidity (SAMM) in the Netherlands and validates the WHO Maternal Near Miss (MNM) tool to detect and monitor SAMM worldwide. The ratio behind the different subjects selected in this thesis is explained by differences in economic disparity throughout the globe. Where the effect of poverty is undeniably present in maternal health care, we hypothesize that wealth might also have a negative impact on pregnancy outcome. Show less
Rulisa, S.; Umuziranenge, I.; Small, M.; Roosmalen, J. van 2015
