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PubMed1993

Emergency peripartum hysterectomy and associated risk factors.

OBJECTIVE: Peripartum hysterectomy at Los Angeles County-University of Southern California Medical Center was reviewed and associated risk factors were identified. STUDY DESIGN: Retrospective descriptive and cohort analysis from January 1985 to June 1990 was carried out. Adjusted relative risks for hysterectomy with 95% confidence intervals for identified risk factors were calculated where possible. RESULTS: There were 123 cases of emergency peripartum hysterectomy (incidence of 1.3/1000 births). Indications for hysterectomy were primarily placenta accreta (n = 61), uterine atony (n = 25), unspecified uterine bleeding (n = 19), and uterine rupture (n = 14). The relative risk of emergency hysterectomy was 95.5 (95% confidence interval 66.7 to 136.9) for cesarean delivery, 10.78 (95% confidence interval 7.56 to 15.37) for prior cesarean delivery, and 97.29 (95% confidence interval 70.28 to 134.70) for placenta previa. CONCLUSIONS: Cesarean delivery, prior cesarean delivery, placenta previa, placenta accreta, and uterine atony were identified risk factors for emergency peripartum hysterectomy.

Adult↗

PubMed1993

Does Doppler-detected fetal movement decrease the incidence of nonreactive nonstress tests?

OBJECTIVE: To determine whether a decreased incidence of nonreactive nonstress tests (NSTs) in antepartum testing was attributable to the addition of fetal movement detection to the standard NST. METHODS: Monitors with standard fetal heart rate recording capabilities were used, as were new monitors producing a Doppler-detected recording of fetal movement (NST-fetal movement). Cross-sectional retrospective analysis of NST results was carried out by chi 2. RESULTS: Comparison of the 10-month period before fetal movement detection to the 10 months including NST-fetal movement monitoring showed a significant decrease in nonreactive NSTs from 5.7% to 3.3% (chi 2 = 61.7, 95% confidence interval [CI] 0.97-0.98). This reduction in nonreactive tests disappeared (3.3% to 5.1%) when the NST-fetal movement-capable monitors were no longer available (chi 2 = 24.2, 95% CI 1.01-1.03). CONCLUSIONS: Nonreactive NSTs decreased by 58% with the introduction of fetal movement monitoring in our antepartum testing center and increased when the NST-fetal movement-capable monitors were removed. A reduced incidence of nonreactive NSTs associated with NST-Doppler-detected fetal movements should effect a savings in both time and resources.

Chi-Square Distribution↗