Emergency peripartum hysterectomy at Jordan University hospital – a teaching hospital experience

Abstract

Introduction Emergency peripartum hysterectomy (EPH) is a foremost operation and is perpetually implemented in the presence of life intimidating hemorrhage during or immediately after abdominal or vaginal deliveries. The aim of this study was to review cases managed at the Department of Gynecology and Obstetrics at Jordan University Hospital (JUH). Material and methods All women who underwent EPH due to any cause in the period from January 2010, to December 2017 were included in the study. Data were collected retrospectively using the patients’ files namelessly. Main measures: age, gravidity, parity, number of previous cesarean sections, previous uterine surgeries, indication for hysterectomy, complications, antepartum bleeding and the need for blood transfusion. Results In total, 74 cases of EPH were managed during the study period. The incidence of EPH ranged from 0.24 to 8.7 per 1000 deliveries. EPH was found to be more common following cesarean sections than vaginal deliveries. The prime indication was abnormal placentation, uterine atony, and uterine rupture. The risk factors included previous cesarean sections, scarred uteruses, multiparity, older age group. Maternal morbidity ranged from 26.5 to 31.5% and mortality from 0 to 12.5% with a mean of 4.8%. Conclusions EPH is the most demanding obstetric surgery performed in very tiresome circumstances of life threatening hemorrhage. The indication for EPH in recent years has changed from outdated uterine atony to abnormal placentation. Antenatal eagerness of the risk factors, engrossment of proficient obstetricians at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in tumbling morbidity and mortality.

Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania

“…The mean estimated blood loss in this study was 2200 mL, ranging from 500 to 5500 mL. The same results were reported in one study where the mean blood loss was 2210 mL and the mean transfusion was 4 blood units [23]. However, other studies have reported a median estimated blood loss ranging from 2.5 to 7.8 L [24,25].…”

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

“… 11 Researchers at Jordan University Hospital also found emergency peripartum hysterectomy to be more common following cesarean compared to vaginal delivery. 16 These results reflect the 20-fold increased risk of infection with cesarean compared to vaginal delivery. 17 Of note, the rate of cesarean delivery in our cohort far exceeds the cesarean delivery rate in sub-Saharan Africa, which is just 5%, compared to 27.2% in high resource countries.…”

“…Seventy-six percent of our cohort delivered via cesarean. 16 Similarly, the study in Rwanda found that 81% of patients who underwent laparotomy secondary to peripartum infection delivered via cesarean. 11 Researchers at Jordan University Hospital also found emergency peripartum hysterectomy to be more common following cesarean compared to vaginal delivery.…”

Routine haemoglobin assay after uncomplicated caesarean sections

“…Qatawneh et al . reviewed cases managed by emergency peripartum hysterectomy (EPH) and found that the estimated blood loss during EPH was 2210 mL, 17.6% of their studied women bled > 3000 cc, and the average number of blood units transfused was 3.93 ± 3.43 [ 26 ].…”