Obstetric hysterectomy: an emergency lifesaving procedure

Abstract

Background:Although rare in modern obstetrics, emergency peripartum hysterectomy (EPH) remains a life-saving procedure, in the event of uncontrollable postpartum hemorrhage. Observations regarding the causes and outcomes of EPH provide valuable insights relevant to the current management perspectives in obstetrics. This study is intended to assess the contemporary prevalence, indications, and outcomes of EPH, at a Tertiary care referral institute. Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 3 years January 2011-December 2013, in the department of obstetrics and gynecology, at the KEM hospital, in Mumbai. Cases of EPH were analyzed for information, maternal age, parity, gestational age, type of delivery, indications for EPH and outcomes of the procedure. Results: The average annual incidence rate was1 per 1000 deliveries. 44% of the cases had an indication of abnormal placentation. 60% of the cases had caesarean section deliveries. Multiparity, previous LSCS, and gestation period of <37 weeks, were the commonly observed associations. 52% of cases required ICU admission. Maternal mortality rate was 8%. 20% of the cases had intrauterine fetal death. Conclusions: Abnormal placentation was evident as the leading cause of uncontrollable hemorrhage. This is possibly in view of a continual improvement in the management of uterine atony, reduced incidence of uterine rupture, and importantly, a rising trend of caesarean section delivery. This calls for more thoughtful considerations, regarding decisions for caesarean section delivery, in obstetrics practice.

Emergency obstetric hysterectomy: A clinical study

“…Total number of births in two years was 10,859. This is higher than other studies like Fatu F et al 0.8 per 1000, [2] 1.2 per 1000 by Shradha Shetty, [6] 0.83 per 1000 by Jaya Chawla [8] and 1 per 1000 by Meena N [9] . Our institute is tertiary care referral centre, with referrals from around the region.…”

“…The incidence of emergency obstetric hysterectomy is higher in the age group 25-35years [3-5, 7-13, 15, 16] and in grand multiparas. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] . In our study too, incidence of emergency peripartum hysterectomies was found to be 50% in this age group and most were multiparas.…”

“…Before proceeding to emergency hysterectomy other lifesaving procedures like balloon tamponade in 7.5%, Blynch suture in 2.5% cases, bilateral uterine artery ligation in 7.5% and internal iliac artery ligation in 5% cases was tried following the pharmacological agents like oxytocin, methergine, misoprostol, injection carboprost. Uterine atony was once the most common cause of emergency obstetric hysterectomy and now there is a decreasing trend from 66.7% to 20% in a review of literature [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . Bladder injury is the most serious co-morbidity in emergency obstetric hysterectomy.…”

“…Maternal mortality rates are higher in peripartum hysterectomy cases. Most of the studies have reported a mortality rate of 7% to 24% [5,[8][9][10][11][12][13]15] . In our study it was 12.5%.…”

Women’s Experiences following Emergency Peripartum Hysterectomy at St. Francis Hospital Nsambya. A Qualitative study.

“…These feelings are contrary to the ones of joy and gratitude which the women had hoped to experience following the birth of their children (10). In sub-Saharan Africa 1 in 200 women will loss their uterus through EPH due to severe PPH compared to the developed world of 1 in 1000 women (11)(12)(13). This is mainly due to lack of skilled attendance at birth, multiparity, prolonged and obstructed labour (14,15).…”