Emergency peripartum hysterectomy: A great obstetric challenge

Abstract

Objective:To determine the prevalence, etiology and complications of emergency obstetric hysterectomy (EOH) at a tertiary care hospital in Karachi.Methods:This was a retrospective cohort study which was carried out in the Department of Obstetrics & Gynecology Unit II, Civil Hospital Karachi from March 2015 to March 2017. All patients undergoing EOH were included in the study. Data was collected from medical files and labor room registers in accordance with ethical guidelines. Information included demographic characteristics, reasons for EOH, procedure associated morbidity and mortality. Data was recorded on a predesigned pro forma and analyzed using IBM SPSS Statistics for Macintosh, Version 18.0.Results:Out of 7,968 deliveries in two years, 32 patients under went EOH, (prevalence 4.01 per 1,000 deliveries). The mean age was 30.0 ± 5.2 years. Most women (75%) were multipara. The main mode of delivery was caesarean section (80%), mostly done as an emergency procedure (81%). In 10(30%) patients EOH was performed for uncontrollable hemorrhage due to uterine atony, followed by a morbidly adherent placenta (28%). Morbidity included disseminated intravascular coagulation (DIC) in four patients(19%) and three patients underwent repeat laparotomy for uncontrollable hemorrhage. There were three maternal deaths, giving a case-fatality index of 9.3%.Conclusion:Uterine atony and morbidly adherent placenta were the main reasons for emergency obstetric hysterectomy (EOH) in our set up.

Emergency Peripartum Hysterectomy In Mendefera Hospital-Case Control Study

“…The incidence is very high in LIC countries, compared to HIC [2,5]. The overall incidence of EPH at our hospital was 2/1000 deliveries, which is higher than those reported in HIC but is lower than the study done by Zeterogluet al in Turkey and in low-income countries [2,5,12,22,23].…”

“…The main issues related to EPH include persistent blood loss, need for blood transfusion, febrile morbidity, conducting a major surgical procedure, end to maternal fertility and higher rate of maternal death [17][18][19][20][21][22][23][24][25][26]. The rates of stillbirth, neonatal death, preterm delivery and admission to the neonatal intensive care unit are also higher in babies of women, who undergo peripartum hysterectomy than babies of women, who do not undergo hysterectomy [3].…”

“…In LIC, uterine atony and ruptured uterus are the most common indication for EPH [16, 18,27].EPH is rare, but is associated with increased rates of maternal and perinatal morbidity and mortality, and procedural complication [1-3, 17-19, 24]. It is arguably one of the most devastating complications in obstetrics, resulting in adverse outcomes for women desiring to maintain their fertility [1-3, 17-19, 24].The main issues related to EPH include persistent blood loss, need for blood transfusion, febrile morbidity, conducting a major surgical procedure, end to maternal fertility and higher rate of maternal death [17][18][19][20][21][22][23][24][25][26]. The rates of stillbirth, neonatal death, preterm delivery and admission to the neonatal intensive care unit are also higher in babies of women, who undergo peripartum hysterectomy than babies of women, who do not undergo hysterectomy [3].There is a lack of data on EPH in Eritrea.…”

Peripartum Hysterectomy: Is There Any Difference Between Emergent versus Planned Surgery ?

“…The higher complication rate is expected in the emergent cases than scheduled surgery. The bladder injury that is the most common complication was observed as 3-20% in several studies 3,7,12,17,23 . A higher incidence of bladder injury(27.2%) was stated in our study in reference to the literature.…”

“…In a large-scaled meta-analysis, the incidence was found as 0.9 per 1000 deliveries 6 . A retrospective cohort study from Pakistan showed higher incidence as 4.01 per 1000 deliveries 12 . We have also observed PPH yielding an incidence of 1.7 per 1000 deliveries in a previous study from our tertiary center 13 .…”