My friend lost her uterus. - Page 2 - Mothering Forums

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#31 of 37 Old 03-05-2008, 11:07 AM
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May I just BUMP this thread up, as this is still happening and you need to protect yourselves ... our younget to come foreward is 17 and her first baby!!!
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#32 of 37 Old 03-05-2008, 12:32 PM
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first of all I am sorry that this happened to your friend.
For me this is not a completely unheard of senario over the years I have known of several hysterectomies also maternal deaths. So not only is your friend's baby alive and well but your friend is alive too. I know that it is said quite a bit on this list the Life risk to a woman who has a C-section is 3-4 times greater than vaginal birth. It is because it is major surgery, the chances that complications like something being nicked or some sort of complication of anesthesia, or of too much blood loss are there. In recent years in the US maternal mortality has been increasing the reason is thought to be the increase in the number of C-sections.
here is one older abstract that shows the increase in risk of peripartum hysterectomy that is associated with c-section .
21%. Although no maternal deaths occurred, maternal morbidity remained high, including postoperative infection in 58 (50%), intraoperative urologic injury in 10 patients (9%), and need for transfusion in 102 patients (87%).

CONCLUSIONS: The data identify abnormal adherent placentation as the primary cause for gravid hysterectomy. The data also illustrate how the incidence of emergency peripartum hysterectomy increases significantly with increasing parity, especially when influenced by a current placenta previa or a prior cesarean section. Maternal morbidity remained high although no maternal deaths occurred. (AM J OBSTET GYNECOL 1993;168:1443-8.)

(C) Mosby-Year Book Inc. 1993. All Rights Reserved.
more recent info
J Obstet Gynaecol. 2008 Jan;28(1):69-72.

Emergency obstetric hysterectomy in a university hospital: A 25-year review.

Rahman J, Al-Ali M, Qutub HO, Al-Suleiman SS, Al-Jama FE, Rahman MS.

Departments of Obstetrics and Gynaecology.

Over the past 25 years, 43 peripartum hysterectomies were performed at the
authors' institution, an incidence of 0.64/1,000 deliveries; 31 procedures
followed caesarean section and 12 were performed for haemorrhage following vaginal delivery. The common indications for hysterectomy were abnormal placentation (39.5%), uterine atony (23.3%), uterine rupture (23.3%), and haemorrhage during caesarean section (11.6%). The risk factors for hysterectomy included advancing maternal age and parity, previous caesarean section scars and abnormal placentation. Subtotal hysterectomy was performed in 72.1% cases which appeared a quicker and safer procedure than total hysterectomy in desperately ill patients. Five (11.6%) maternal deaths occurred in the series. Mortality was associated with massive haemorrhage. With rising caesarean section rates worldwide, MRI and colour Doppler sonography is useful to diagnose antepartum
placenta accreta/bladder involvement in order to plan elective surgery that is
associated with reduced maternal morbidity and mortality. Early decision to
perform an emergency hysterectomy is essential before the patient's condition deteriorates, besides availability of an experienced obstetrician to undertake a technically demanding operation.

PMID: 18259903 [PubMed - in process]
this is from the UK and they have lower rates than we do

Obstet Gynecol. 2008 Jan;111(1):97-105.

Cesarean delivery and peripartum hysterectomy.

Knight M, Kurinczuk JJ, Spark P, Brocklehurst P; United Kingdom Obstetric
Surveillance System Steering Committee.

National Perinatal Epidemiology Unit, University of Oxford, United Kingdom.

OBJECTIVE: To estimate the national incidence of peripartum hysterectomy and quantify the risk associated with cesarean deliveries and other factors. METHODS: A population-based, matched case-control study using the United Kingdom Obstetric Surveillance System, including 318 women in the United Kingdom who underwent peripartum hysterectomy between February 2005 and February 2006 and 614 matched control women. RESULTS: The incidence of peripartum hysterectomy was 4.1 cases per 10,000 births (95% confidence interval [CI] 3.6-4.5). Maternal mortality was 0.6% (95% CI 0-1.5%). Previous cesarean delivery (odds ratio [OR] 3.52, 95% CI 2.35-5.26), maternal age over 35 years (OR 2.42, 95% CI 1.66-3.58), parity of three or greater (OR 2.30, 95% CI 1.26-4.18), previous manual placental removal
(OR 12.5, 95% CI 1.17-133.0), previous myomectomy (OR 14.0, 95% CI 1.31-149.3), and twin pregnancy (OR 6.30, 95% CI 1.73-23.0) were all risk factors for peripartum hysterectomy. The risk associated with previous cesarean delivery was higher with increasing numbers of previous cesarean deliveries (OR 2.14 with one previous delivery [95% CI 1.37-3.33], 18.6 with two or more [95% CI 7.67-45.4]). Women undergoing a first cesarean delivery in the current pregnancy were also at increased risk (OR 7.13, 95% CI 3.71-13.7). CONCLUSION: Peripartum hysterectomy is strongly associated with previous cesarean delivery, and the risk rises with increasing number of previous cesarean deliveries, maternal age over 35 years, and parity greater than 3. LEVEL OF EVIDENCE: II.

PMID: 18165397 [PubMed - indexed for MEDLINE]
what I find interesting in this review is out of the total number of hysterectomies 39, 37 were c-section related and 21 were related to previa- so in this group 2 emergency hysterectomies after vaginal birth and 37 after c-section.

J Reprod Med. 2000 Sep;45(9):733-7.

Indications for and outcomes of emergency peripartum hysterectomy. A five-year

Bakshi S, Meyer BA.

Department of Obstetrics and Gynecology, University Medical Center, State
University of New York at Stony Brook 11794-8091, USA.

OBJECTIVE: To review risk factors, management and outcomes of emergency
peripartum hysterectomy performed in the last five years at Stony Brook
University Hospital. STUDY DESIGN: Retrospective descriptive and cohort analyses from January 1990 to January 1995. Incidences of emergency peripartum hysterectomy and placenta accreta were determined. Relative risks of hysterectomy for specified risk factors were calculated. RESULTS: There were 39 cases of emergency peripartum hysterectomy, for an overall incidence of 2.7/1,000 births. Indications for emergency hysterectomy were placenta accreta, unspecified bleeding, uterine rupture, myomas and atony with placenta accreta, the most common. The crude relative risk of emergency hysterectomy was 46.9 (n = 37) for cesarean delivery, 15.24 (n = 31) for prior cesarean delivery and 110.83 (n = 21) for placenta previa. CONCLUSION: Cesarean delivery, prior cesarean delivery,
placenta accreta and uterine atony were identified as risk factors for emergency peripartum hysterectomy, and abnormal placentation was the primary cause of cesarean hysterectomy.

PMID: 11027082 [PubMed - indexed for MEDLINE]
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#33 of 37 Old 03-05-2008, 01:03 PM
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I know its hard to think of this now, but someone needs to get her a lawyer ASAP who will get hard copies of all charting and paperwork before it "goes missing" as these things are wont to do when the doctor has screwed up. Don't give them time to rewrite, change or misplace things. Don't let anyone talk settlement with her or get her to sign anything at all. In fact, someone needs to be with her at all times as she will be on powerful pain meds and to easily manipulated. It is a horrific loss on so many levels and so unnecessary. I know some else here in MD that this happened to. She was so traumatized she never did sue, but I wish she had because the case was egregious and this doctor should have been barred from practicing.
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#34 of 37 Old 03-05-2008, 01:18 PM
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i have seen one uterus taken in about 3 years. It was very serious, but 1 week after delivery. I could see the major artery nicked, but not the cervix tear.
I am very sorry!
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#35 of 37 Old 03-05-2008, 03:27 PM
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As in lots of cases the notes are writen up INaccurately at the time - like mine. The docs know what to write to stop them from being sued - like my situation ...
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#36 of 37 Old 03-05-2008, 07:51 PM
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My time in law school taught me that, if anything, doctors are under-sued when compared to the medical mistakes that happen. To sue someone is very expensive, and not likely to pay out. If you do win, it is often appealed and you may never see a dime. There are sanctions against lawyers for frivolous lawsuits. There is this misconceptions that everyone runs around suing everyone all the time. My husband was unlawfully fired and was owed money by the company, commissions he had 100% earned, and we were told that we might as well not bother, it wouldn't be worth it and we probably wouldn't win anyway. That was just asking some questions, because the way he was treated was dead wrong. The problem here is malpractice insurance more than these crazy litigious Americans.

ETA: I just saw a story the other day about how many hysterectomies are done, and that 2/3 are unnecessary. I have no idea about this particular case obviously.

Laura, CBE and mom to Maddiewaterbirth.jpg ( 06/03/04) & Graceuc.jpg (  09/10/06)
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#37 of 37 Old 03-10-2008, 12:27 AM
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A local woman here passed away during a cesaren when the Dr. mistakenly knicked the uterine artery. Unfortunately the mother bled out. It sounds to me, in the heat of the moment, the Dr. thought the artery was knicked, and in order to save her life, he removed her uterus.

Your friend is very lucky that her artery was not knicked, however it is very unfortunate that her uterus was removed really for no reason.
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