Emergency Peripartum Hysterectomy: A Multicenter Study of Incidence, Indications and Outcomes in Southwestern Nigeria

Abstract

Objective To determine the incidence, indications and outcomes of emergency peripartum hysterectomy (EPH) in three tertiary institutions in south-west Nigeria between January, 2010 and December , 2013. Methods A retrospective review of all cases of EPH over a 4 year period was done. EPH was defined as hysterectomy performed at the time of delivery or within 24 h of delivery for uncontrollable postpartum bleeding not responsive to conservative measures. Relevant information was extracted from the hospital records and operation notes. Statistical analysis was done using SPSS software version 17.0. Statistical significance was set at p < 0.05. Results There were 102 EPHs performed among 39,738 deliveries within the study period, giving a rate of 2.6 per thousand deliveries. Indications were uterine rupture (44.1 %), uterine atony (37.3 %), morbidly adherent placenta (17.6 %) and extension of caesarean section incision involving the uterine arteries (1 %). Subtotal hysterectomy was performed in most cases (67.6 %).Maternal case fatality rate was 11.8 % and perinatal mortality rate was 55.9 %. Blood transfusion, severe postoperative anaemia, wound sepsis, febrile morbidity and acute kidney injury were common morbidities associated with the procedure. Following multivariate logistic regression, the unbooked status [odds-ratio 95 % CI = 12.80 (1.22-133.97) p = 0.03] was the only variable that significantly predicted maternal death. Conclusion The incidence of EPH from our study is high. Much more needs to be done in maternal health services, particularly provision of quality obstetric care to reduce the rates of EPH and the associated high maternal and perinatal morbidity and mortality.

An analysis of the practices of caesarean section in sub-Saharan Africa: A summary of the literature

“…Table 3. The main maternal post-operative complications associated with caesarean sections are: surgical site infections, obstetric fi stulae, pulmonary embolism, postpartum haemorrhage, maternal death, and the peroperative complications are anaesthetic complications, complicated haemorrhage in haemostatic hysterectomy and maternal death [10,15,16,19,21,28,33,[37][38][39]45,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] [12,[63][64][65][66][67][68][69][70][71][72][73][74][75]…”

Emergency peripartum hysterectomy in a tertiary hospital in Antananarivo, Madagascar

“…In Africa, perinatal death varies between 18.8% and 81%. 5,14,21,22 This mortality rate can be as high as 64 to 81% in the literature. This high perinatal mortality is mainly observed in case of uterine rupture and retroplacental hematoma.…”

“…uterine atony uterine rupture abruptio placentae placenta accreta age is relatively young compared to other studies in Africa which average age varies between 28.1 and 32.76 years old. 5,15,21,22 . In India, the average age varies between 29.9 years old and 30.25 years old.…”

“…This frequency varies from 66.7% to 96.4%. 5,14,19,[21][22][23] According to certain authors, cesarean sections are the source of hemorrhages. [26][27][28] In present study, the retroplacental hematoma, the case of placenta accreta, were already, themselves, risk factors for the hemorrhage of delivery.…”

“…This rate varies between 65.85% and 92.8%. 5,[14][15][16]22 In developed countries, this rate ranges from 54.9% to 87% of subtotal hysterectomy cases. 29 In India, this rate varies between 26% and 88.09%.…”