BACKGROUND Emergency Peripartum Hysterectomy (EPH) implies removal of uterus at the time of delivery or in the immediate postpartum period, usually carried out as a last resort in uncontrollable life-threatening obstetric haemorrhage. Recent studies show an increase in these procedures being done for abnormal placentation, which refers to both placenta praevia and morbidly adherent placenta praevia or accreta. The aim of the study is to determine the incidence, indications, risk factors and complications of Emergency Peripartum Hysterectomy (EPH). MATERIALS AND METHODS This is a retrospective case series involving detailed examination of the case records of patients for 3 years who had emergency peripartum hysterectomy between January 2013 and December 2015 in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode. We analysed the incidence, indications, risk factors, type of hysterectomy and the complications of emergency peripartum hysterectomy. RESULTS There were 49,125 deliveries of which 65.22% were vaginal and 34.78% were by caesarean section. Hundred and five women underwent emergency peripartum hysterectomy giving an incidence of 2.1 per 1000 deliveries. The indications of EPH were mainly placenta previa with prior caesarean section. Morbidly adherent placenta was seen in 60 of the 63 (60%) cases followed by atonic PPH (19%) and rupture uterus (10.47%). There were two cases of maternal death. Inadvertent cystotomy was the most important complication in our series (6.66%). Sixty nine (65.7%) had previous delivery by caesarean section and 74 (70.4%) women delivered by caesarean section. CONCLUSION Morbidly adherent placenta in women with prior CS was the most common indication to perform emergency peripartum hysterectomy. Timely decision for hysterectomy significantly reduced the maternal morbidity and is a lifesaving procedure.
Background: Unengaged head in a primigravida at term gestation at the onset of labor is considered as an obstetric risk factor for dysfunctional labor. Careful monitoring of the progress of labor and timely medical intervention reduced the risk of dysfunctional labor and Cesarean delivery. This study was to assess the effect of unengaged head on course of labor, duration of labor, its maternal and fetal outcome in primigravida at term in labor. Methods: This prospective cross-sectional study was conducted in 100 primigravida with term gestation, unengaged head with spontaneous onset of labor meeting the inclusion criteria admitted to labor ward, Department of Obstetrics & Gynecology, ESIC-MC & PGIMSR Hospital, Bengaluru during January 2019 to June 2020. After detailed clinical evaluation, labor monitored partographically and CTG for fetal surveillance and when necessary, interventions like augmentation of labor and operative vaginal or cesarean delivery performed. Results: Among 100 primigravidae, 19% had floating head, 53% at -3 and 28% at -2 station at the time of onset of labor. The mean duration of 1st, 2nd stage and total duration of labor was higher in freely floating head compared to -3 and -2 station. The need for augmentation of labor was 100% with freely floating head than with -3 and -2 station. 77% delivered vaginally and 23% by LSCS, arrest disorders being the main indication. There was no significant difference in maternal morbidity or APGAR score at 5 min. 88% of the babies delivered with good APGAR and 12% required NICU admission Conclusions: Our study demonstrates that higher the fetal head station at the onset of labor, greater the duration of labor and the need for augmentation. Unengaged head per se is not an indication for LSCS as 77% of them delivered vaginally with partographically monitored labor.
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