Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Assistant Professor
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Calcutta National Medical College & Hospital , Kolkata




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C.S. Ramesh Babu,
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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : QC10 - QC15 Full Version

Emergency Peripartum Hysterectomy in a Tertiary Care Centre of North India during COVID-19 Pandemic: A Retrospective Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56598.16513
Jigyasa Singh, Shikha Sachan, Deeksha Singh, Uma Pandey

1. Assistant Professor, Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. 2. Associate Professor, Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. 3. Resident, Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. 4. Professor, Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Correspondence Address :
Dr. Jigyasa Singh,
Department of Obstetrics and Gynaecology, Institute Of Medical Sciences, Banaras Hindu University, Varanasi-221005, Uttar Pradesh, India.
E-mail : drjigyasasingh06@gmail.com

Abstract

Introduction: The pandemic of Coronavirus Disease 2019 (COVID-19) had a significant impact on obstetric surgeries. Obstetric surgical procedures during the COVID-19 pandemic affect individuals who are suspected or proven to be high-risk endeavors.

Aim: To evaluate the demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes in the women who had an Emergency Peripartum Hysterectomy (EPH) during the first and second waves of the COVID-19 at a tertiary care centre in North India.

Materials and Methods: This was a retrospective cohort study, conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in Uttar Pradesh, India, including women who underwent EPH operated from March 2020 to May 2021 in terms of demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes. Information about their self-reported health issues due to traumatic birth (when they came for a follow-up visit at five weeks) were also obtained. Simple frequency, percentage, and proportion were calculated using descriptive statistics.

Results: A total number of 1827 deliveries were conducted and out them 11 cases underwent emergency peripartum hysterectomy at our institute during the time frame of the COVID-19 pandemic. All of the patients were in their 20s or 30s, with ages ranging from 21 to 34. All of these were unplanned pregnancies and arrived at various gestational ages. Eight cases had the previous scarring on the uterus, with six women having morbidly adhered placenta. All of the women in the study cohort were unbooked, and 72.73 % (eight out of 11) of them were referred to our centre because they had high-risk factors. Due to substantial blood loss, five females required Critical Care Unit (CCU) support. The study sample had a poor newborn outcome, with three early neonatal deaths out of 11 deliveries. As a part of their 5th-week follow-up, after the women had been stabilized and discharged from the ICU, they were asked to share their major issues related to health, psychological status and social interaction. The main worries revolved around the newborn child's and COVID-19 positive husband’s health. Pregnant women who delivered during the COVID-19 pandemic had a significant rate of postpartum depression and Post-traumatic Stress Disorder (PTSD).

Conclusion: The predominant cause of EPH in the study population was a morbidly adherent placenta. It is critical to protect women’s physical and psychological health during traumatic childbirth in order to mitigate the pandemic's already-existing harmful impacts.

Keywords

Coronavirus disease, Morbidly adherent placenta, Obstetric caesarean hysterectomy, Postpartum haemorrhage

The Coronavirus Disease 2019 (COVID-19) pandemic outbreak had a significant impact on people's lives all around the world (1). The COVID-19 pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), started in December 2019 in Wuhan, Hubei Province, China, and instantly spread around the world. The World Health Organization (WHO) declared it a Public Health Emergency of International Concern (PHEIC) on January 30th 2020 (2). The Indian Government has announced a statewide lockdown in the first phase that will commence on March 23, 2020, as a preventive measure to limit the spread of the virus (3),(4). Various government regulations, particularly those addressing the health sector, have undergone significant modifications. While health facilities continued to provide necessary services, elective procedures had to be reduced for hospital resources to be diverted to the COVID-19 pandemic. The record indicates that the COVID-19 pandemic in India peaked in September 2020 and then gradually declined until the nadir was reached in February 2021, after which cases again increased until May 2021, when the next peak occurred, considering the first wave from September 2020 to January 2021 and the second wave from February 2021 to May 2021 (5).

The Ministry of Health and Family Welfare issued recommendations in collaboration with Federation of Obstetricians and Gynaecologists of India (FOGSI) to provide uninterrupted health services to pregnant women who are considered a high-risk population (6). Despite this, analysis indicates that during the rigorous lockdown, the acceptability of crucial maternal health care dropped dramatically (7). Travel restrictions, fear of contracting COVID-19 and a lack of health facilities in low-resource communities all contributed to a reduction in prenatal visits. As a result of this ignored health check-up status, many women attend labour phases with high-risk variables, making them vulnerable to labour complications and emergency surgery (8).

The parturient experiences a range of feelings during labour and childbirth, ranging from joy and elation to agony and grief in the event of a traumatic birth (9). Every woman enters the birth room hoping to feel excitement and pride as a result of her maternal instinct (10). However, this happy occasion can sometimes be accompanied by negative emotions such as melancholy, emptiness, and a sense of worthlessness (10),(11),(12),(13). The parturient's physical, mental, and psychological well-being might be significantly impacted by an Emergency Peripartum Hysterectomy (EPH). According to the literature, one out of every 1000 women in the world has EPH (14), (15). The emotional and psychological repercussions of a caesarean hysterectomy are little understood. The patient population, in this case, is a young woman who is already in a vulnerable mental state, and exposing her to this horrific life event may worsen her mental state. Post-traumatic Stress Disorder (PTSD) is recognized to be linked to a traumatic birthing experience (16).

Furthermore, during the COVID-19 pandemic, females who delivered newborns reported increased levels of stress during labour. The current pandemic scenario may have an impact on her emotional and social well-being. Since the outbreak of the COVID-19 pandemic, every new patient in our hospital is considered a COVID-19 suspect until the test results are negative. As a result, pregnant women who require immediate delivery but do not have their COVID-19 test results receive necessary care in a COVID-19 suspicious area, assuming the risk of contracting COVID-19 from other patients in the same room if one of them tests positive for infection (17),(18). This only adds to her anxiety associated with lower quality maternal-infant bonding (19).

With this goal in mind, authors sought to study women who had EPH during the COVID-19 pandemic in terms of socio-demographic characteristics, indications, intraoperative and postoperative complications, and health concerns connected to a traumatic birth. As limited data is available in the literature, this study is distinctive in that it is the first to examine the details of EPH cases with a focus on their own health difficulties as a result of a traumatic birth during the COVID-19 pandemic.

Material and Methods

This retrospective cohort study was conducted in the Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, a tertiary care centre in Uttar Pradesh, India among pregnant female who underwent EPH operated from March 2020 to May 2021. The Institutional Ethical Committee of the Institute of Medical Sciences at BHU approved this study with letter number BHU/IEC/21/405. This institute serves a large population area, and the nationwide lockdown made movement difficult, even in an emergency. Authors began using telemedicine to continue delivering routine antenatal care, reducing the number of physical visits for low-risk mothers. All COVID-19 safeguards were being taken by emergency services.

Inclusion and Exclusion criteria: All the EPH cases between March 2020 and May 2021 were included in the study. This study also included all women who were delivered outside and were referred to our institution for obstetric complications requiring a hysterectomy. Postpartum hysterectomies performed for gynaecological reasons were excluded from the study.

Procedure

Emergency Peripartum Hysterectomy: Hysterectomy conducted for bleeding resistant to other therapeutic measures at the time of caesarean section or vaginal delivery, or within 48 hours of puerperium, was classified as EPH (14).

The cause of the delay was recorded for every unbooked or referred case. Authors inspected the case files and the electronic medical records of the institution for patients who underwent EPH and noted previous antenatal visits, demographic variables such as age, parity, gestational age, planned or unplanned pregnancy status , reasons for the delay in seeking medical help, mode of delivery, and operative variables such as indication for EPH, type of uterine incision, intraoperative findings, blood loss, and need for blood transfusion. The information regarding the infant's live delivery, birth weight, neonatal Intensive Care Unit (ICU) admission, and period of separation from the baby was retrieved too. Their case files also contained information about their self-reported health issues due to traumatic birth (when they came for a follow-up visit at five weeks).

Statistical Analysis

All cases of EPH had baseline demographic data, intraoperative, and postoperative outcome variables recorded in a tabular format. Simple frequency, percentage and proportion were calculated using descriptive statistics. The data analysis was done in the month of March 2022.

Results

A total number of 1827 deliveries were conducted in the time span from March 2020 and May 2021. Out them 11 cases underwent emergency peripartum hysterectomy at the institute during the time frame of the COVID-19 pandemic.

All of the patients were in their 20s or 30s, with ages ranging from 21 to 34. All of these were unplanned and unbooked pregnancies and arrived at various gestational ages. Eight out of 11 cases (72.737 %) had the previous scarring on the uterus (Table/Fig 1).

The indications and intraoperative findings of EPH cases are shown in (Table/Fig 2). General anaesthesia was used in all the cases. The central placenta praevia was present in cases 4, and 11.

Case 5 was referred with a breech presentation with posterior wall fibroid with hypothyroidism. There was a big posterior wall intramural fibroid approximately the size of 7×8 cm with atonic Postpartum Haemorrhage (PPH). Bleeding could not be controlled despite stepwise devascularisation, so a hysterectomy was performed. Case 7 presented on postoperative day one with placenta accreta, postpartum haemorrhage and shock, as well as puerperal sepsis. Case 8 presented to us on postoperative day 2 with placenta accreta, postpartum haemorrhage, and shock with COVID-19 positive status. Total 72% of the cases (eight out of 11) were referred by local hospitals and district hospitals. Case 7 had a severe postpartum haemorrhage that, despite continual devascularisation, bleeding persisted, necessitating hysterectomy (Table/Fig 3). Case 10 was referred to us with obstructed labour and COVID-19 positive status. She was diagnosed with a ruptured uterus with atomic PPH. A foetus was present in the peritoneal cavity with hemoperitoneum. The uterus was ruptured from the upper segment in J shaped manner, the foetus was attached to the placenta via umbilical cord, the placenta was in the uterine cavity, the uterus could not be repaired due to torrential traumatic PPH hysterectomy was done.

(Table/Fig 4) shows that all of the patients required massive blood component transfusions both during and after surgery. The ICU care was required for five out of 11 patients (45.45%).

(Table/Fig 5) shows the features of the infants with the length of time they were separated from their mothers. Two neonates were found to be COVID-19 positive.

Their main issue was related to the health of the newborn (Table/Fig 6).

During their 5th week follow-up, all of these patients reported some issues related to physical health, psychological status, and social interaction associated with their earlier traumatic birth, as seen in (Table/Fig 7). Guilt at the baby's death, tiredness, concerns about femininity and sexual health, and posttraumatic stress flashbacks to the ICU stay were all major concerns.

Discussion

Emergency peripartum hysterectomy is a life-saving obstetric surgery performed as a last resort in an emergency to control intractable postpartum haemorrhage (20),(21).

Due to the surgical intervention, extended intubation, organ dysfunction, massive blood loss, multiple blood transfusions, resuscitation, and ICU admission involved with EPH, it is characterised as severe maternal morbidity, or even near-miss maternal fatality (22).

Goyal M et al., looked at the impact of the COVID-19 pandemic on maternal health as a result of a delay in seeking medical help. During the pandemic, 32.5% of pregnant women received fewer prenatal visits, according to the researchers. The main reasons for the delay in seeking assistance were a rigorous lockdown that resulted in a shortage of mobility facilities (50.9%) and a fear of contracting COVID-19 (33.4%) (23).

In population-based research, Orbach A et al., found comparable rising trends in EPH (24). Dimirci O et al., found 39 cases of EPH over a 9-year period at a tertiary obstetric centre. Of these, 34 were performed after caesarean section and five after vaginal birth (25). With increased caesarean section rates, the incidence of adhered placentas, uterine rupture, and atonic postpartum haemorrhage is on the rise, resulting in an increase in EPH cases (26).

Though this may be avoided if detected early with doppler sonography and magnetic resonance imaging, hysterectomy is typically the only option when a woman arrives in labour.

The EPH is coupled with significant blood loss. The mean blood loss in the present study sample was 2.83±1.34 mL, compared to 3467±2110 mL in a study by Chibber R et al., (27). Due to substantial blood loss, five ladies required critical care unit (ICU) support. In the present study, one of the women died, although Chibber R et al., found two maternal deaths (27).

In the present study, it was found that the main worries revolved around the newborn child's and husband's health. Ostacoli L et al., concluded in their study that the pregnant women who delivered during the COVID-19 pandemic had a significant rate of postpartum depression and Post-traumatic Stress Disorder (PTSD) (28). The pregnancy experience and other individual characteristics were found to be more closely linked to postnatal psychological discomfort than previously thought. The ability to provide targeted preventive and therapeutic psychological therapies necessitates early identification of an insecure attachment style during pregnancy (29).

Such women's emotional health may be exacerbated by traumatic childbirth. Physical effort, loss of femininity, and remorse over the death of a child were the main issues in the present study group of nine EPH patients. Women rarely speak about their psychological health, particularly in rural areas, so healthcare practitioners typically overlook this element of postpartum care. By understanding the experience and consequences of EPH, healthcare practitioners can better comprehend the problems of these women and contribute to the fulfilling of the requirements of health. Herein lies the value and necessity of a prenatal psychiatric session for a mother who has experienced a traumatic birth (30).

Women who have survived EPH and other near-miss maternal events are considered as clinical triumphs, but many of them may have unmet mental health needs, because they have survived childbirth. The authors agrees with Tsuno K et al., that any woman who has had a traumatic childbirth should have a prophylactic psychological session as part of her postpartum follow-up visits and simply ensuring that women survive a near-miss event does not guarantee a positive clinical outcome, since many of these women may suffer in silence and anguish as a result of traumatic childbirth (31). Clinical guidelines would include promoting proper health care, specialized treatment, and even screening tests to rule out the possibility of postpartum depression. This would aid in the early detection of women who are at risk of developing postpartum depression, thus reducing the detrimental repercussions. By enhancing our understanding of postpartum requirements, we can address the unmet mental health issues of women having an emergency obstetric hysterectomy. Future studies are required to fill the information gap on EPH in terms of experience and its consequences.

Limitation(s)

To begin with, the study may have been improved if we had utilized a standard questionnaire to address post-traumatic stress disorder and depression, as well as identify patients at risk for stress and depression, but because it was a retrospective study, we were unable to do so, limited by data availability and a lack of long-term follow-up of patients who had EPH. Second, because EPH is a relatively uncommon procedure, the number of patients in our study was small. Furthermore, because our research was conducted in a hospital, it reflected the experience of a referral centre, and it is only applicable to our institution or similar contexts.

Conclusion

The predominant cause of EPH in the study population was a grossly adherent placenta. All of the women in the present study cohort were unbooked. In women undergoing peripartum hysterectomy, authors discovered a higher frequency of prior caesarean, placenta praevia, and morbidly adherent placenta. Multiparous women who have had a previous or current caesarean delivery or have abnormal placentation are at the highest risk of needing an emergency hysterectomy. As a result, avoiding a primary caesarean section during the first pregnancy is critical in lowering the chance of peripartum hysterectomy. Early surgical intervention and prompt resuscitation in a well-equipped referral centre likely minimised morbidity and saved maternal death.

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DOI and Others

DOI: 10.7860/JCDR/2022/56598.16513

Date of Submission: Mar 24, 2022
Date of Peer Review: Apr 23, 2022
Date of Acceptance: May 07, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 01, 2022
• Manual Googling: Apr 15, 2022
• iThenticate Software: May 05, 2022 (20%)

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