Peripartum hysterectomy in the 1990s: any new lessons?

Abstract

We aimed to identify the risk factors and subsequent maternal and perinatal outcome associated with the procedure of peripartum hysterectomy. This was a retrospective case review carried out at the National Maternity Hospital, Dublin, of all patients who underwent a peripartum hysterectomy from January 1990 to December 1999. Seventeen cases were performed during the study period from a total of 64 563 deliveries (0.03%). Mean maternal age was 34 years (21-43). There were no nulliparous patients. Eight patients had previous vaginal deliveries. The other nine had a history of previous caesarean section, four of whom had two or more caesarean sections. The indications for the hysterectomy were placenta praevia (5), secondary postpartum haemorrhage (3), abruptio placentae (3), atonic postpartum haemorrhage (2), placenta accreta (2), traumatic postpartum haemorrhage (1) and broad ligament haematoma (1). All patients received blood transfusions, 74% receiving more than 10 units. There were no maternal deaths. There were two neonatal deaths secondary to placental abruption (perinatal mortality rate 118/1000). In conclusion, there was no maternal death in this study but the associated maternal morbidity and perinatal mortality was high. More than half the cases were associated with previous caesarean section. The caesarean section rate is increasing worldwide for many reasons, including recent emphasis on maternal request. We recommend that caesarean section be performed only for valid clinical indications, which should help to reduce the problems associated with peripartum hysterectomy.

Emergency Obstetric Hysterectomy: A Retrospective Study from a Teaching Hospital in North India over Eight Years

“…23,24 However, in cases of morbidly adherent placenta total hysterectomy may prove more beneficial as removal of the cervix leads to better hemostasis. 25 In our study, eight cases underwent total hysterectomy. Seven of these cases were those of morbidly adherent, low lying placenta and one case was of uterine rupture.…”

Incidence, indications, and maternal outcomes of emergency peripartum hysterectomy at a tertiary hospital in Ethiopia: A retrospective review

“…A study performed in Nigeria in 2012 found that the rate of EPH was 4.0 per 1000 deliveries 9 . The rate is lower in European countries: a rate of 0.2 per 1000 births was reported from Norway, 10 and 0.3 per 1000 births from Ireland 11 and the Netherlands 12 . This may be because of proper use of effective prenatal and delivery facilities, and the desire for small family size in Europe 11–14 …”

“…12 This may be because of proper use of effective prenatal and delivery facilities, and the desire for small family size in Europe. [11][12][13][14] In Ethiopia, hemorrhage has been the leading cause of mortality in recent years, followed by hypertensive disorders of pregnancy and sepsis, whereas the contributions of obstructed labor/uterine rupture and abortion have decreased over the same period. 15 Although the causes of maternal mortality are well studied in Ethiopia, there are no data on incidence and maternal outcomes of EPH.…”

Emergency peripartum hysterectomy in Isfahan; maternal mortality and morbidity rates among the women who underwent peripartum hysterectomy

“…[123] Cesarean delivery is the major risk factor for peripartum hysterectomy and due to recently raising cesarean delivery rate and the increasing population with a scarred uterus, the incidence of emergency peripartum hysterectomy may indirectly increase. Historically, the most common indication cited for peripartum hysterectomy was uterine atony[456789] but, more recent reports have suggested that abnormal placentation, including placenta accreta, has become the most common indication for peripartum hysterectomy. [1011]…”