Studies

Peripartum hysterectomy

[Data collection for this study is complete. Analysis in progress]

Background

Severe obstetric haemorrhage is a leading cause of severe maternal morbidity in Australia and remains a cause of maternal death. One-off studies on peripartum hysterectomy have shown that the incidence is increasing1 and that there is an association between prior caesarean delivery and the need for peripartum hysterectomy.2 The caesarean section rate in Australia continues to increase, with the most recent figures showing that over 30% of women gave birth by this mode in 2005, compared with less than 20% in 1996.3 There is an urgent need to explore the epidemiology and management of peripartum hysterectomy in Australia.

Research questions

  1. What is the current incidence of peripartum hysterectomy in Australia and New Zealand?
  2. What are the risk factors for peripartum hysterectomy in Australia and New Zealand?
  3. How is severe obstetric hemorrhage resulting in peripartum hysterectomy managed?
  4. What are the outcomes for both the woman and the infant when a pregnancy results in peripartum hysterectomy?

Method

Prospective, case-control study using monthly negative surveillance system of all birthing services in Australia and New Zealand (>50 births) – AMOSS. Nominated clinicians and midwives within each maternity unit will be e-mailed a simple tick-box to indicate whether a case occurred or whether there is ‘nothing to report’. If a case arose, the reporting clinician will complete a case form using the secure web-based data system. The clinician/midwife will also complete two control forms using the secure web-based data system. Only non-identifiable data will be collected.

Study period

January 2010 - December 2011 (Aust) 2012 (NZ)

Case definition

The cases will be all women in Australia and New Zealand identified as having a peripartum hysterectomy using the following definition:
EITHER any woman whose pregnancy terminates and who has a hysterectomy in the same clinical episode or within six weeks postpartum when the indication for hysterectomy is related to the pregnancy e.g. secondary postpartum haemorrhage
OR any woman giving birth and undergoing a hysterectomy in the same clinical episode or within six weeks postpartum when the indication for hysterectomy is related to the birth e.g. secondary postpartum haemorrhage

Control selection

The two women giving birth immediately prior to the woman with the condition, in the same hospital.

Study size

The study was initially run for 18 months. The estimated sample size for this time duration was 330 cases based on the Victorian obstetric haemorrhage and associated hysterectomy study conducted for the years 1999 – 2002.1 The incidence of peripartum hysterectomy was shown to be increasing consistently over these years, with 48 hysterectomies performed in Victoria in 2002, from a pool of 61 959 maternities; 7.7 per 10,000 maternities. This is a larger sample estimate than that made based on the UKOSS results: between 100 and 130 cases based on the UKOSS results of 4.1 (95%CI 3.6 to 4.5) per 10,000 maternities.2

Investigators

AMOSS CHIEF INVESTIGATORS

Professor Elizabeth Sullivan, Principal Investigator AMOSS, Professor of Public Health, Assistant Deputy Vice Chancellor, University of Technology Sydney and Conjoint Professor, UNSW Medicine, New South Wales

Professor David Ellwood, CI AMOSS, Director of Maternal-Fetal Medicine, Professor of Obstetrics & Gynaecology, Deputy Head of School Research, Gold Coast Health District, Queensland and Deputy Dean, College of Medicine, Australian National University, Australian Capital Territory

Professor Michael Peek, CI AMOSS, Associate Dean, Department of Obstetrics and Gynaecology, Medical School, College of Medicine, Biology and Environment, The Australian National University and Centenary Hospital for Women and Children, Australian Capital Territory

Professor Caroline Homer, CI AMOSS, Professor of Midwifery, Associate Dean: International and Development, Associate Head, WHO Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology Sydney, New South Wales

Professor Lisa Jackson Pulver, CI AMOSS, ProVice Chancellor Engagement and Aboriginal and Torres Strait Islander Leadership, Western Sydney University, New South Wales 

Professor Marian Knight, NIHR Professor of Maternal and Child Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, UK.

Dr. Claire McLintock, CI AMOSS, Obstetric physician and haematologist, National Women's Health, Auckland City Hospital, New Zealand

AMOSS ASSOCIATE INVESTIGATORS

Professor Elizabeth Elliott, Professor of Paediatrics & Child Health, The University of Sydney and Australian Perinatal Statistics Unit, The Children's Hospital Westmead New South Wales

Clinical Assoc Professor Nolan McDonnell, Staff Specialist Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth Western Australia

Dr Tessa Ho, Trustee, Mary Aitkenhead Ministries

Dr Wendy Pollock, Honorary Research Fellow, La Trobe University/Mercy Hospital for Women, Melbourne Victoria

Associate Professor Yvonne Zurynski, The University of Sydney and Australian Perinatal Statistics Unit, The Children's Hospital Westmead New South Wales

Funding and other support

We gratefully acknowledge our funding partners and participating AMOSS sites.

Initial funding was through a five year project grant (Australian National Health and Medical Research Council NHMRC #510298 2008-2012), which provided support for the first set of AMOSS studies as well as the AMOSS infrastructure.

The University of New South Wales provided support to redevelop the AMOSS site with a Major Research Equipment and Infrastructure Initiative (MREII) Grant in 2013.

Other funding support has been provided through the University of Technology Sydney.

Data collection is supported by AMOSS participating sites.

References

  1. Haynes, K., C. Stone, and J. King, Major Conditions Associated with Childbirth in Australia: Obstetric Haemorrhage and Associated Hysterectomy. 2004, Department of Human Services: Melbourne.
  2. Knight, M., et al., Cesarean delivery and peripartum hysterectomy. Obstetrics & Gynecology, 2008. 111(1): p. 97-105.
  3. Laws, P.J., et al., Australia's mothers and babies 2005, in Perinatal statistics series no. 20. Cat. no. PER 40. 2007, AIHW National Perinatal Statistics Unit: Sydney.

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