Objectives: To report the outcome of patients undergoing supracervical (SCAH) compared to total (TAH) abdominal emergency peripartum hysterectomy (EPH) for postpartum hemorrhage (PPH). Data sources: A systematic search was conducted in Medline, Embase, and Cochrane Library from January 2000 to December 2024, using MeSH terms and keywords related to peripartum hysterectomy and maternal outcomes. Study eligibility criteria: STUDY DESIGN: Observational cohort and case-control studies. Population: Patients undergoing emergency SCAH vs. TAH for PPH within 24 hours of delivery. Exclusion criteria: Studies exclusively reporting cases with placenta accreta spectrum (PAS), case reports, conference abstracts, and studies with <10 cases per arm. Study appraisal and synthesis methods: Two independent reviewers screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS). Head-to-head meta-analyses were conducted using random-effects models. Heterogeneity (I2) and publication bias were assessed. Results: 25 studies were included, analyzing 1,478 patients (715 SCAH, 763 TAH). No significant differences were found in maternal mortality (p=0.532), ICU admission (p=0.415), reoperation (p=0.884), or major complications (p>0.05). SCAH was associated with: Lower risk of ureteric injuries (OR: 0.38, 95% CI 0.18-0.77; p=0.007). Reduced estimated blood loss (EBL) (MD: -446.03 mL, 95% CI -747.72 to -144.35; p=0.004). Fewer blood transfusions (MD: -1.46 units, 95% CI -2.37 to -1.14; p=0.002). Shorter operative time (MD: -53.22 min, 95% CI -86.48 to -19.95; p=0.002) CONCLUSION: SCAH appears to offer advantages over TAH in emergency PPH cases, particularly in reducing ureteric injuries, operative time, and blood loss. However, heterogeneity and lack of standardized PAS diagnosis criteria limit the generalizability of findings. Future research with standardized protocols is required to refine surgical decision-making.
Lucidi, A., Janiaux, E., Buca, D., Nieto-Calvache, A.J., Khalil, A., Rizzo, G., et al. (2025). Outcome of supra-cervical compared to total hysterectomy for emergency peri-partum hemorrhage: a systematic review and meta-analysis. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 234(2), 321-349 [10.1016/j.ajog.2025.09.033].
Outcome of supra-cervical compared to total hysterectomy for emergency peri-partum hemorrhage: a systematic review and meta-analysis
Flacco, Maria ElenaMethodology
;Manzoli, LambertoPenultimo
Formal Analysis
;
2025
Abstract
Objectives: To report the outcome of patients undergoing supracervical (SCAH) compared to total (TAH) abdominal emergency peripartum hysterectomy (EPH) for postpartum hemorrhage (PPH). Data sources: A systematic search was conducted in Medline, Embase, and Cochrane Library from January 2000 to December 2024, using MeSH terms and keywords related to peripartum hysterectomy and maternal outcomes. Study eligibility criteria: STUDY DESIGN: Observational cohort and case-control studies. Population: Patients undergoing emergency SCAH vs. TAH for PPH within 24 hours of delivery. Exclusion criteria: Studies exclusively reporting cases with placenta accreta spectrum (PAS), case reports, conference abstracts, and studies with <10 cases per arm. Study appraisal and synthesis methods: Two independent reviewers screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS). Head-to-head meta-analyses were conducted using random-effects models. Heterogeneity (I2) and publication bias were assessed. Results: 25 studies were included, analyzing 1,478 patients (715 SCAH, 763 TAH). No significant differences were found in maternal mortality (p=0.532), ICU admission (p=0.415), reoperation (p=0.884), or major complications (p>0.05). SCAH was associated with: Lower risk of ureteric injuries (OR: 0.38, 95% CI 0.18-0.77; p=0.007). Reduced estimated blood loss (EBL) (MD: -446.03 mL, 95% CI -747.72 to -144.35; p=0.004). Fewer blood transfusions (MD: -1.46 units, 95% CI -2.37 to -1.14; p=0.002). Shorter operative time (MD: -53.22 min, 95% CI -86.48 to -19.95; p=0.002) CONCLUSION: SCAH appears to offer advantages over TAH in emergency PPH cases, particularly in reducing ureteric injuries, operative time, and blood loss. However, heterogeneity and lack of standardized PAS diagnosis criteria limit the generalizability of findings. Future research with standardized protocols is required to refine surgical decision-making.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
