A district‐wide population‐based descriptive study of emergency peripartum hysterectomy in a middle‐income country

Abstract

Objective To determine incidence, risk indicators, and outcomes of emergency peripartum hysterectomy (EPH) in Metro East, Cape Town, South Africa. Methods A population‐based district‐wide prospective descriptive study of EPH in public hospitals from November 2014 to November 2015. Women were enrolled by using the WHO maternal near miss tool and followed until discharge. EPH was defined as hemorrhage or infection leading to hysterectomy during pregnancy or within 42 days of delivery. Results Fifty‐nine women experienced EPH with an overall incidence of 14.3 per 10 000 women: 32 procedures were for postpartum hemorrhage, 27 for puerperal sepsis. Two women died: one from sepsis; one from hemorrhage. Overall, 51 (86%) women delivered by cesarean, and 23/51 (45%) by repeat cesarean. As compared with hemorrhage, EPH for sepsis involved older women (mean age, 31.5 vs 24.4 years) and those with higher gravidity (median, 3 vs 1), and was associated with longer hospital admission (median, 11.5 vs 4 days), with occurrence later postpartum (median, 8 vs 0 days), and more frequently with complications. Conclusions The incidence of EPH for sepsis was higher than previously reported. Repeat cesarean was strongly associated with EPH. Clinical characteristics of sepsis‐related EPH compared unfavorably with those of hemorrhage‐related EPH.

Uterine Factor Infertility, a Systematic Review

“…For the African continent, according to 17 epidemiological studies, the annual incidence of hemostasis hysterectomies among all deliveries ranged from 0.12% in South Africa to 1.25% in Niger [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ].…”

Clinical and Sociodemographic Characteristics Associated with Emergency Peripartum Hysterectomy due to Puerperal Sepsis in Malawi

“…The fatality rate of emergency peripartum hysterectomy is the highest in low-resource settings. 4 In its criteria for assessing maternal health quality of care, the WHO includes the performance of emergency peripartum hysterectomy secondary to infection as a "maternal near-miss" -an event in which a woman "nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy." 3,5 While the mortality associated with puerperal sepsis in sub-Saharan Africa is significant and exceeds that in high resource settings, we lack an accurate estimate of its true incidence and impact.…”

“…Recent studies in South Africa found that puerperal sepsis was a primary indication for emergency peripartum hysterectomy in up to 46% of cases. 4 , 9 , 10 A standard protocol guiding emergency peripartum hysterectomy secondary to puerperal sepsis remains unclear and there is a scarcity of recent literature regarding clinical course and outcomes in settings with limited access to antibiotics. As a result, the incidence of emergency peripartum hysterectomy is greatly influenced by clinical impression and factors such as delayed recognition of puerperal sepsis, availability of adequate antibiotics, and delays in transfer to specialist care at the tertiary center.…”

“…As a result, the incidence of emergency peripartum hysterectomy is greatly influenced by clinical impression and factors such as delayed recognition of puerperal sepsis, availability of adequate antibiotics, and delays in transfer to specialist care at the tertiary center. 4 , 11 The surgeon is left with a difficult dilemma: remove the infection source (uterus) to preserve the life of the patient at the cost of her fertility, or preserve the uterus and fertility but risk worsening infection and possible death for the patient.…”

“…A recent study in South Africa found that emergency peripartum hysterectomy due to puerperal sepsis was higher than previously reported and had worse outcomes than hemorrhage-related emergency peripartum hysterectomy. 4 A study investigating maternal near-miss in Rwanda observed the lack of a standard protocol for managing puerperal sepsis with emergency peripartum hysterectomy. 11 The primary objective of this study, therefore, was to identify demographic and clinical characteristics associated with mortality for women undergoing laparotomy due to puerperal sepsis in Malawi.…”