Evaluation of Cause of Peripartum Hysterectomy:A Retrospective Study in a Tertiary Care Hospital

Abstract

Introduction: Peripartum hysterectomy is a surgical venture which is performed at the time, or within 24 hours, of delivery. Emergency peripartum hysterectomy (EPH) is a major surgical venture which is performed during or immediately after or within 24 hours of abdominal and vaginal deliveries. It is also performed during or after caesarean section delivery. This surgical venture which is done when the situation of the patient becomes very critical and there lies life-threatening and huge bleeding after vaginal delivery or cesarean delivery. Despite many advances has been achieved in medical and surgical fields, studies have found out that in developing countries, massive obstetrical hemorrhage causes 8-10% of maternal death directly. So, this study has undertaken to assess the risk factors, indications, causes, outcome and complications of emergency caesarean/peripartum hysterectomy along with demographic factors. Objective of the Study: The objective of this study was to determine the incidence, indications and causes of peripartum hysterectomies. Materials and Methods: This study was a retrospective analysis of the records of women who emergency had been the sufferer of emergency peripartum hysterectomy in a tertiary care hospital. The records of the cases were retrieved from the internal medical records department for the purpose of the study. The socio-demographic characteristics of the patients, indications for the hysterectomy, causes of hysterectomy, mode of delivery, number of cesarean section and baby outcome were recorded in a pre-designed data form. The data were analyzed using simple proportion, rates and tables. Result: 50 women underwent peripartum hysterectomy during the study period. The incidence was 9.3/1000 deliveries. Main indications of peripartum hysterectomies were placenta accreta (44.4%), and uterine rupture (11.1%), Central placenta Previa (Percreta) (11.1%). The common maternal complications were febrile morbidity, bladder injury, disseminated intravascular coagulation, and wound infection. There were 7 maternal deaths following emergency peripartum hysterectomy done for atonic PPH whereas no mortality occurred in elective hysterectomy group. Conclusion: Emergency peripartum hysterectomy is considered to be an essential life-saving surgical venture and the rates of this surgical venture is rising gradually in our community in comparison with the developed countries. Effective maternal care, ensuring emergency response, identifying patients at risk stage, enhancement of blood transfusion facilities, improvement of surgical skills, giving training to them who are associated with the treatment procedure and overall increasing the awareness among the women may help to reduce the incidence of peripartum hysterectomy as well as maternal morbidity and mortality.

JBSA 2023; 36 (1) : 28-32