Poster Session 3
Daniel J. Martingano, DO, MBA, PhD
Clerkship Director, IRB Chair, Associate Program Director / Division Chair
St. John's Episcopal Hospital-South Shore and William Carey University College of Osteopathic Medicine
Far Rockaway, New York, United States
Amanda F. Francis Oladipo, MD, MSCR (she/her/hers)
Director of Research
Hackensack University Medical Center
Hackensack, New Jersey, United States
Marwah Al-Dulaimi, MD (she/her/hers)
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Sandra Kumwong, MS
Medical Student
Touro College of Osteopathic Medicine-Harlem Campus
New York, New York, United States
Andrea Ouyang, MSc
Medical Student
William Carey University
Hattiesburg, Mississippi, United States
Lauren Cue, MD, BA (she/her/hers)
OB/GYN Resident
Rutgers University and the Jersey City Medical Center
Jersey City, New Jersey, United States
Ashley Nguyen, MD
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Francis X. Martingano, MD
Assistant Professor, Senior Minimally Invasive Surgeon
NYU Grossman School of Medicine - NYU Brooklyn
New York, New York, United States
Shailini Singh, MD
Director of Metabolic Syndrome
AtlantiCare Regional Medical Center
Pamona, New Jersey, United States
Mark Rebolos, MD
Director of Patient Safety, Labor & Delivery
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Kristin Cohen, CNM, DNP
Women's Health Care Practitioner
RWJBarnabas Health - Trinitas Regional Medical Center
Elizabeth, New Jersey, United States
Alexander Ulfers, DO
Medical Director, Maternal Infant Care Center; Maj, USAF, MC
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
Donald Morrish, MD
Chief Executive Officer
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Iffath A. Hoskins, MD
Former ACOG President, Director of Labor & Delivery, Chief Safety Officer
Albert Einstein College of Medicine - Montefiore Medical Center
New York, New York, United States
Emergent peripartum hysterectomy may be required as a lifesaving procedure for sever postpartum hemorrhage (SPPH). SPHH requiring hysterectomy can rarely be associated with severe complications such as unintended oophorectomy or Sheehan syndrome, which respectively can lead to vasomotor sequelae. This study sought to evaluate the effectiveness of nonhormonal treatment regimens for vasomotor sequelae in patients with pregnancies complicated by SPHH requiring peripartum hysterectomy.
Study Design:
We conducted a multi-center, prospective observational study from 7/2019 to 7/2024 comparing all pregnant patients requiring a peripartum hysterectomy due to SPHH and endorsed vasomotor symptoms up to 6-months postpartum. Monotherapy clonidine 24-hour patch, paroxetine, gabapentin, black cohosh, sertraline, and fluoxetine were included as covariates. Patients less than 34 0/7 weeks gestation, with prior endocrine or rheumatology disorders, or allergies to or prior use of any of the covariates were excluded. The primary outcomes included patient-reported resolution of daytime and/or nighttime symptoms confirmed by provider assessment and the need to switch medication, as discrete events.
Results:
The study included 27 patients who reported vasomotor symptoms following SPHH requiring hysterectomy. Study groups' demographics were not significantly different. 16 (59.3%) patients had complications of unintended oophorectomy, 20 (74.1%) were diagnosed with Sheehan Syndrome, and 9 (33.3%) were diagnosed with both conditions. Patients using the clonidine 24-hour patch were more likely to achieve daytime vasomotor symptom resolution (92.6% v. 18.5%, p=0.030) and were less likely to switch medications (85.2% v. 22.2%, p=0.004). Patients using paroxetine at doses of 10mg or greater were more likely to achieve resolution of both nighttime vasomotor and insomnia symptoms compared to non-use (88.9% v. 11.1%, p=0.021).
Conclusion:
Clonidine and paroxetine are reasonable nonhormonal treatment therapies for vasomotor sequelae in patients with pregnancies complicated by SPHH requiring peripartum hysterectomy.
