Survey Of Peripartum Hysterectomy Experiences Anticipated, Unplanned, Or Averted

INTRODUCTION: To evaluate the experiences related to peripartum hysterectomy among first-year maternal-fetal medicine Fellows in the United States. METHODS: A cross-sectional anonymous survey was administered at the Society for Maternal-Fetal Medicine first-year Fellow annual retreat in March 2013. Fellows were asked about prior experiences, management strategies for suspected abnormal placentation, uterine tamponade devices, and antifibrinolytic agents. Statistical analysis was performed using univariate and bivariate methods. RESULTS: There was a 56% response rate (55/99) for completed surveys. Compared with the East Coast, Fellows from West Coast programs have performed more hysterectomies (mean values with standard deviations 2.9±2.4 compared with 1.2±1.2, P=.004). Only 25% of responders felt adequately trained to perform a peripartum hysterectomy as the supervising physician. Handheld cautery devices such as the Ligasure or Gyrus were used by 29% during a peripartum hysterectomy. In situations in which preoperative ultrasonography showed abnormal placentation, only 16% always obtained a preoperative magnetic resonance image. Sixty-five percent responded that their institution never recommend planned delayed hysterectomies. In cases of postpartum hemorrhage resulting from uterine atony, there was a wide variation in the use and management of uterine balloon tamponade devices. The median incremental time for balloon deflation was every 5 hours (interquartile range 2–12) by 25% (interquartile range 20–50). CONCLUSIONS: There is wide variation in practice among first-year maternal-fetal medicine Fellows in management of anticipated, unplanned, or averted peripartum hysterectomies. Given the serious morbidity and mortality associated with these clinical situations, development of management guidelines is warranted.