A 26-Year Review of Emergency Peripartum Hysterectomy in a Tertiary Teaching Hospital in Kuwait – Years 1983–2011

Abstract

Objective: To identify the risk factors and study the incidence, indications and complications of emergency peripartum hysterectomy (EPH). Materials and Methods: This was a retrospective case-control study. The cases consisted of all women who underwent EPH between January 1983 and January 2011. Two controls per case were randomly selected from the remaining deliveries by using a random number table. Case records were retrieved from the medical records. Results: Among 150,993 deliveries, there were 59 EPHs (cases), giving a rate of 0.390 per 1,000. Of the 59 cases, only 56 were analysed because 3 files were unavailable. These women were older (mean age 36 ± 5.7 vs. 22 ± 5.3 years, p < 0.01) and had delivered more than 1 child (p = 0.02). Thirty-seven (66%) cases had had previous caesarean sections (CSs) and the number of CSs in this group was greater than in the controls (21%, p < 0.01). More index cases had a history of atonic postpartum haemorrhage (46 vs. 4%, p < 0.001) and placenta praevia (34 vs. 4%, p < 0.01). More cases than controls were delivered by CS (73 vs. 29%; p = 0.003). The leading indications for EPH were haemorrhage due to uterine atony and placenta praevia. Independent risk factors were older age, multiparity, history of one or more CSs and placenta praevia. There were 2 maternal deaths from coagulopathy following massive obstetric haemorrhage. The main complications of EPH were febrile morbidity: 12 (21%), wound infection: 8 (14%) and bladder or ureteric injury: 8 (14%). Conclusions: CSs, especially repeat CSs in women with placenta praevia and persistent uterine atony, significantly increased the risks of peripartum hysterectomy.

Emergency Peripartum Hysterectomy: A 13-Year Review at a Tertiary Center in Kuwait

“…The incidence of EPH of 1.07 per 1,000 deliveries in our series compares favorably with other reported incidences [4,5,13,16]. In agreement with recent published studies [4][5][6][7][8][9][10][11], the commonest cause of EPH in our series was abnormal placentation (77.4 %), followed by uterine atony (14.5 %) and uterine rupture (8.1 %).…”

“…As this procedure inevitably brings an end to woman's child bearing capacity, it can be devastating for some couples. Several studies have reported its incidence from the Middle East region ranging from 0.39 to 5.38 per 1,000 deliveries [16][17][18]. The objectives of this study are to determine the incidence, indications, risk factors, and complications of EPH and to evaluate the total versus subtotal hysterectomy for EPH in our institution for the period from January 2000 to December 2012.…”

Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide

“…Interstudy heterogeneity was assessed using x 2 test for heterogeneity. 1,[4][5][6]9,10,[91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110] Two studies were analyzed as one (same sample), 4,113 so the total number of papers was considered 128. Pooled odds ratio (OR) with 95% CI was calculated for categorical variables.…”

“…1,6,17,19,20,[23][24][25][26][27][28][29]31,33,34,37,38,40,41,43,[45][46][47][48][49][50][51][52][53]57,58,60,62,64,72,78,83,86,87,93,94,96,[105][106][107][108][109]112,114,[118][119][120][121]…”

Maternal Outcome in Emergency Peripartum Hysterectomy: Minimizing the Risks

“…17 This figure is much lower than a report from Riyadh KSA but comparable to observations from Kawait. 18 Improved and efficient blood banking services, antibiotics, safe anesthesia and advances in surgical technique are the major factors contributing to better outcomes and reduced maternal mortality rates. The present study confirms the earlier observations that EPH is associated with high maternal morbidity.…”