Maternal Outcome in Emergency Peripartum Hysterectomy: Minimizing the Risks

Abstract

Objective: To study the incidence, causes and maternal outcome in emergency peripartum hysterectomy. Materials and methods:Retrospective, descriptive study of emergency peripartum hysterectomy by analyzing the labor records of patients undergoing the procedure in the past 5 years.Results: There were 57 emergency hysterectomies among the 28940 deliveries, over the past 5 years. The incidence of EPH was 1.97 per 1000 deliveries. The mean age of the patients was 35.03  5.9 (range: 21-47) years. Mean parity was 4.8  2.8 (range: 0-13). Of 57 patients, 50 (87.7%) patients had previous history of cesarean section (CS). The main indications for hysterectomy were placental abnormalities 63.1% (OR = 1.54; 95% CI = 9.5-13.34, p-value <0.001) and uterine atony 24.5% (OR = 1.42; 95% CI = 7.43-15.43, p-value <0.001). Subtotal hysterectomy was performed in majority 50 (87.7%) of the cases. Bladder injury was the significant intraoperative complication in 17 (30%) cases (OR = 1.87; 95% CI = 9.45-18.97, p-value <0.001) with no residual damage. Infections were the commonest complication seen in 15 (26%) patients postoperatively. The maternal mortality occurred in 2 (3.5%) patients. Conclusion:Emergency peripartum hysterectomy, though uncommon, remains a challenging but life saving procedure in obstetrics. Its indications in modern obstetrics are changing and still emerging. Abnormal placentation, previous CS, multiparity are important risk factors. Antenatal diagnosis of low lying and adherent placenta, minimizing the CS rate, proper and timely management of third stage of labor and emergency preparedness are imperative to minimize the chances of emergency peripartum hysterectomy and improving the outcome.

Complications of emergency obstetric hysterectomy in Gujarat, India

“…2,[8][9][10][11][12][13][14][15][16][17][18] In this study, 26-30 years is the age group having highest frequency of the emergency obstetric hysterectomy, the obvious reason is the more frequency of pregnancy in the age group. 62% (28 out of 45) cases were multigravida; uterine injury because of previous pregnancies, low haemoglobin level and repeated caesarean section are aggregating factors making multigravida vulnerable for obstetric hysterectomy.…”