Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

Abstract

IntroductionEmergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman's life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria.MethodsThe case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied.ResultsThere were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%.ConclusionEmergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.

Timing and reasons for antenatal care booking among women in a tertiary health care center in Southern Nigeria

“…This overconfidence is misplaced as several studies have continued to document increased and sometimes frightening complications in this group of women. 20 Non-indigenes tended to book early. This may be due to the fact that itinerant workers in the state are composed mostly of civil servant's bankers and workers in the oil industry who are well educated.…”

Obstetric Hysterectomy As A Surgical Intervention in the Management of Obstetric Haemorrhage At the University of Port Harcourt Teaching Hospital, Nigeria.

“…[23] These complications probably reflect the state of the patients pre operatively with regard to blood loss, presence of sepsis and inadequate intrapartum supervision. These could be prevented by early referral of these cases to well-equipped centers, which can treat emergency obstetric cases promptly and efficiently.…”

“…Sub-total abdominal hysterectomy was the most commonly performed surgical procedure in our review as also documented in some other studies. [7,17,23,24] This appears to be the procedure of choice to control uncontrollable obstetric haemorrhage in affected patients as it is relatively easier and quicker to perform. In addition, in patients with extensive uterine rupture it is associated with less postoperative morbidity since the infected and torn/ragged uterus is removed.…”

“…[6] The perinatal mortality rate of 575/1000 births following EOH was similar to findings from other developing countries including Nigeria. [23][24][25][26] This may have been influenced by the most common indication for obstetric hysterectomy in this study, which was extensive uterine rupture with its devastating consequences on the fetus.…”

Changing trends in incidence, type, indication and maternal outcome of peripartum hysterectomy over 10 years at a tertiary care centre

“…5 Currently, the incidence of peripartum hysterectomy is reportedly rising all over the world associated with rise in the incidence of caesarean section rates, placenta praevia and morbidly adherent placenta.…”