Emergency peripartum hysterectomy in a Nigerian hospital: a 20-year review

Abstract

Postpartum haemorrhage is a major cause of maternal morbidity and mortality and occasionally severe enough to warrant hysterectomy to prevent maternal death. Hysterectomy often is fraught with danger and regular audit is necessary to assist in the reduction of these dangers. A 20-year audit of all emergency peripartum hysterectomies, performed at Havana Specialist hospital Lagos, Nigeria, is reported. Of the 6599 deliveries and peripartum referrals seen during the period, 22 had an emergency hysterectomy as a result of severe postpartum haemorrhage (0.33%). The aetiological factors associated with the postpartum haemorrhage included uterine atony (45.5%), placenta praevia (27.3%), pathologically adherent placenta (18.2%) and ruptured uterus (9.1%). The majority of the procedures were subtotal hysterectomy (81.8%) and the mean operative time was significantly shorter than for total hysterectomy (P<0.05). The postoperative complications included postoperative anaemia (28.6%), febrile morbidity (36.9%), wound infection (19.0%) and urinary tract infection (9.5%), together with three maternal deaths. In conclusion, emergency peripartum hysterectomy, although life-saving, is associated with severe morbidity and mortality and subtotal hysterectomy is usually the operation of choice.

Emergency peripartum hysterectomies at Muhimbili National Hospital, Tanzania: Review of cases from 2003 to 2007

“…Relatively lower percentages of STAH have been reported in other studies elsewhere (Kastner et al 2002;Ezechi, et al, 2004;Selo-Ojeme et al, 2005;Ozden et al, 2005;Rahman et al, 2008). The decision to do total or subtotal emergency hysterectomy depends on the experience of the surgeon performing the operation and the condition of the patient.…”

“…The incidence of emergency peripartum hysterectomy varies from 2 to 10 per 1000 deliveries (Engelsen et al, 2001;Okogbenin et al, 2003;Zamzami, 2003;El-Jallad et al, 2004;Kwame-Aryee et al, 2007). Some studies have reported excessive haemorrhage in the third stage of labour due to uterine atony or placenta praevia as the common indication for emergency peripartum hysterectomy (Zamzami, 2003;Ezechi et al, 2004) while other studies have shown ruptured uterus to be the common indication (Chew & Biswas, 1998;Okogbenin, et al, 2003).…”

Peripartum Hysterectomy and Analysis of Risk Factors

“…In our study the mean maternal age was 26 years which is in contrast to many other studies where peripartum hysterectomy was done in women with mean maternal age >30 yrs. 8 This reflects the difference in the mean age of obstetric population at different places and countries and in developed countries the shift of maternal age towards elderly group is due to literacy and advancement in artificial reproductive technology.…”

Clinical analysis of 52 obstetric hysterectomies

“…Poręba et al, and Jagielska et at., in 90.6% and 87.5% of the surgeries [23,26]. Amputation of the uterine corpus is less challenging technically, and is connected with shorter procedure time, less blood loss, and fewer complications [1,9,10].…”

“…Amputation of the uterine corpus is technically less challenging, connected with shorter time of the procedure, less blood loss, and fewer complica-www. journals.viamedica.pl/ginekologia_polska tions [1,9,10]. The steadily growing rate of cesarean sections results in a higher number of obstetric hysterectomies.…”