Emergency peripartum hysterectomy

Abstract

Objectives: To review the incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy performed after cesarean section and vaginal deliveries. Study design: A nine years retrospective study of all those cases who underwent peripartum hysterectomy at Patan Hospital from the year 1997 to 2005. Results: There were total 28 cases of emergency peripartum hysterectomy, 16 caesarean hysterectomies, and 12 postpartum hysterectomies, with the incidence of 1 per 1364 deliveries. The most common indication for hysterectomy was uterine atony (35.7%) followed by uterine rupture (25%). Average estimated blood loss was 1600 ml, average time from delivery to hysterectomy was 130 minutes, the most common post operative complication was unspecified fever and the average length of hospitalization was 11.17 days. There was only one maternal mortality with 32% maternal morbidity and four perinatal mortality. Conclusion: Peripartum hysterectomy is usually associated with significant maternal and fetal morbidity and mortality yet it remains a potentially life saving procedure. Timely decision to intervene is essential for the optimum outcome. Uterine atony is the leading indication for emergency hysterectomy performed followed by rupture uterus and morbid adherent placenta. Key Words: Caesarean hysterectomy; Peripartum hysterectomy; Postpartum hysterectomy doi:10.3126/njog.v1i2.2395 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 33-36 Nov-Dec 2006

Nine years review of emergency peripartum hysterectomy at tertiary care university teaching hospital

“…6 Both are less than reports from other developing countries. In a Nigerian study perinatal mortality was 73.3% and 53.7% in a Pakistani study.…”

“…5 The frequency of EPH in current study was lower than 0.07% reported in previous study done in this center. 6 The cause of lower incidence is uncertain, and could be due to improved overall health care facilities in recent years. In a study done in Karachi, the frequency of obstetric hysterectomy was 1 in 368 deliveries (0.27%), 7 in Khan's study 8 the incidence was 10.52 in 1000 deliveries which was very high.…”

“…Whereas in a study done before in the same center the first indication was uterine rupture (25%). 6 Complications occurred in 39% of EPH. Hemorrhagic shock in three (11%, two due to atony and one due to morbid placenta) was the most common complication followed by urinary bladder injury in two (7%, both had history of previous cesarean).…”

Emergency peripartum hysterectomy in a tertiary hospital in Upper Egypt: six years analysis

“…16 The first successful obstetric hysterectomy was carried out in 1876 by Eduardo Porro from Italy 17 and it was used to prevent maternal mortality from PPH. Before this first successful EPH, classic CS was associated with nearly 100% maternal mortality.…”

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

“…Though the first operation of caesarean hysterectomy was originally proposed in 1768 by Joseph Cavallini in Florence [4], the first successful Obstetric hysterectomy was carried out in 1876 by Eduardo Porro from Pavia, Italy [5]. Currently, the incidence of peripartum hysterectomy is reportedly rising all over the world [2].…”