Background. Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Purpose. To determine the incidence, risk factors, indications, outcomes, and complications of EPH performed in a tertiary teaching hospital and to compare the results with other reports in the literature. Methods. The medical records of 13 patients who had undergone EPH, between January 2000 and December 2010, were reviewed retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results. There were 13 EPHs out of 31.767 deliveries, a rate of 0.41 per 1,000 deliveries. Eight hysterectomies were performed after cesarean delivery and five after vaginal delivery. The most common indication for hysterectomy was uterine atony (10/13), followed by placenta previa (2/13). There were one case of intraoperative bladder injury and one case of relaparotomy because of hemoperitoneum. We had one maternal death because of septic shock. There were no cases of neonatal morbidity and mortality. Conclusion. Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face.
IntroductionEmergency peripartum hysterectomy (EPH) is an uncommon obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. [1][2][3] It was first proposed in 1869 but with no desirable results [4]. However, seven years later (1876), the first cesarean subtotal hysterectomy was carried out successfully, with the result that both the mother and the baby survived [5]. In modern obstetrics, the overall incidence of EPH is 0.05%, but there are considerable differences in incidence in different parts of the world, depending on modern obstetric services, standards and awareness of antenatal care, and the effectiveness of family planning activities of a given community [6]. The incidence of peripartum hysterectomy in the literature is reported as 0.24, 0.77, 2.3, and 5.09 per 1,000 deliveries by Sakse et al. [7], Whiteman et al. [8], Bai et al. [9] and Zeteroglu et al. [10], respectively. However, there is a lack of Portuguese data on EPH. To our knowledge, there is no Portuguese information on EPH.Severe postpartum hemorrhage was reported to occur in 6.7/1,000 deliveries worldwide. It is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face [11]. The main causes of the uncontrollable hemorrhage necessitating an EPH have changed since the 1980s [2]. Uterine atony and rupture have been overtaken by abnormal placentation in many studies. This is not only because of improved conservative management of uterine atony and a reduced incidence of uterine rupture due to the extensive use of the lower uterine segment inci...