Experience of Emergency Peripartum Hysterectomies at a Tertiary Care Hospital in Quetta, Pakistan

Abstract

Emergency peripartum hysterectomy (EPH) is associated with significant morbidity and mortality worldwide. The purpose of our paper was to determine the incidence, morbidity, and mortality of EPH done at our institution; the largest tertiary care government hospital in the city of Quetta, Pakistan. During the study period there were 12,642 deliveries, out of which 46 women had undergone an EPH, translating into an incidence of ∼4 per 1,000 births. Disturbingly, 82.6% of these patients had received no antenatal care prior to their presentation. There were 4 (8.7%) maternal deaths and 31 (67.4%) perinatal deaths. The commonest indication noted was uterine rupture in 21 (45.7%) cases. Lack of antenatal care is indeed a modifiable factor that needs to be addressed to help reduce maternal and fetal morbidity/mortality not only from emergency hysterectomies but also from all other preventable causes.

Changing trends in emergency peripartum hysterectomy in a tertiary obstetric center in Turkey during 2000–2013

“…Postpartum hemorrhage is a leading cause of maternal morbidity and mortality (2-4). The incidence of EPH varies from 0.2-1.6 per 1000 deliveries per year in developed countries, with a higher incidence in developing countries (5)(6)(7). Indications for peripartum hysterectomy have changed throughout the years.…”

“…Indications for peripartum hysterectomy have changed throughout the years. In developing countries, uterine atony and uterine rupture are the most common indications for EPH, but in developed countries, abnormal placental invasion is the most common indication (1,7). In particular, the increasing rate of cesarean delivery worldwide has been associated with an increasing rate of placenta previa and accreta (8).…”

Clinical analysis of 52 obstetric hysterectomies

“…Elective (oncologic) causes -connected with history of cancer or concomitant malignancy of the genital tract and uterine rupture -were the third cause for surgery in our study population (9.6%), but the first indication for obstetric hysterectomy in some Polish and international publications [6,24,27].…”

“…Also, significant differences in hysterectomy rates are observed depending on the region of a given country. Kayabasoglu [6,19]. Obviously, the rates of obstetric hysterectomies are correlated with the role they play in the perinatal care system.…”

“…The literature offers definitions ranging from 'until 72 hours postpartum' to '3-6 weeks after birth' [4][5][6]. Inclusion of obstetric hysterectomy into our analysis allows for a complete evaluation of the incidence and prevalence of hysterectomy.…”