Emergency Peripartum Hysterectomy at a Tertiary Care Hospital: A Five Year Analysis

Abstract

Aims: To analyze the medical records of emergency peripartum hysterectomy in a teaching hospital
 Methods: A hospital based descriptive cross-sectional study was carried out on emergency peripartum hysterectomy at National Medical College and Teaching Hospital, Birgunj, Nepal from July 2011 to July 2016. Data were collected from the medical record.
 Results: There were 29 maternal survivors out of 33 cases of emergency peripartum hysterectomy, among which 21 cases were of subtotal and rest 11 had undergone total hysterectomy. The incidence of emergency peripartum hysterectomy was found out to be 0.2%. Most of the women who had undergone hysterectomy were of high parity (≥4) and advanced maternal age. Mean age of hysterectomy was 27 years. Major indications for hysterectomy were uterine rupture (n=13, 40%) followed by uterine atony (n=11, 33%), placental complications (n=8, 24%) and uterine inversion (n=1, 3%). Three-fourth of women who underwent hysterectomy for placental complications had history of previous caesarean section. Emergency peripartum hysterectomy following caesarean section was 19 (57.6%) and the rest 14 (42.4%) had delivered vaginally. Twenty-six women (79%) were referred-in cases.
 Conclusions: Majority (88%) of peripartum hysterectomies were maternal near-miss and resulted in mortality of 12%. Uterine rupture and atony constituted almost three-fourth of cases and emergency procedure was in rising trend each year over five years of record.
 Keywords: caesarean section, peripartum hysterectomy, postpartum haemorrhage

Postpartum Hemorrhage: Incidence, Causes and Maternal Outcomes at Muhimbili National Hospital, Tanzania—A Retrospective Descriptive Hospital-Based Study

“…Another explanation for this increase rate of hysterectomy in this study might be due to significant linear increase in uterine rupture. This finding relates to that in Nepal, where hysterectomy trend was increasing over the years with majority of cases arising from uterine rupture leading to PPH [37]. With an increase number of cesarean sections unpublished data from Tanzania by Zahra et al, showed that in the ten-year period there was a rise in rate of peripartum hysterectomy from 2008 to 2017 [38].…”