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Hasra Snaggs

Hasra Snaggs

Brookdale University Hospital and Medical Center
USA

Title: Cesarean hysterectomy:experience in an urban medical center

Biography

Hasra Snaggs is an obstetrician-gynecologist in Brooklyn, New York and is affiliated with Brookdale Hospital Medical Center. She received her medical degree from State University of New York Upstate Medical University and has been in practice for 3 years. She is one of 21 doctors at Brookdale Hospital Medical Center who specialize in Obstetrics & Gynecology

Abstract

Background:Peripartum hysterectomy is associated with significant morbidity and mortality. It is performed in 0.77 to 2.5/1000 deliveries. The most common indications for cesarean hysterectomy are uterine atony and placenta accreta, the occurrence likely due to the increase prevalence of primary and repeat cesarean deliveries. Brookdale University Hospital and Medical Center is situated in the Brownsville section of Brooklyn, an area nationally noted for significant maternal comorbidities resulting in adverse perinatal outcomes. Methods: A retrospective review of pregnant patients that presented BHMC who underwent a cesarean hysterectomy between 2006 and 2012. Data was collected from inpatient clinic charts. Maternal characteristic, intrapartum characteristics and post-operative complications were analyzed. Results: Thirty women were identified that underwent cesarean hysterectomy. Median age was 30, women with high parity (3 or greater), gestational age of 35 weeks, African American descent, Obese (BMI 32.5) were noted. Sixty three percent of the women had prior at least one prior cesarean. The most common pre-operative indications for a cesarean hysterectomy were atony (37%), placenta accreta (30%), other (20%). All women required transfusion and 30% required ICU admission postoperatively Conclusion: There is increased risk of cesarean hysterectomy with prior cesarean. There was an increased prevalence of obesity and preterm labor, resulting in early delivery. Our findings have resulted in several key changes within our department to decrease the morbidity and mortality related to peripartum hysterectomy, inclusive of interdisciplinary preoperative counseling, initiation of a hemorrhage protocol/drills, and a rapid operative response team, results which have served to decrease adverse perinatal outcomes in our institution