Emergency Peripartum Hysterectomy: A Multicenter Study of Incidence, Indications and Outcomes in Southwestern Nigeria.

Abstract

Objective To determine the incidence, indications and outcomes of emergency peripartum hysterectomy (EPH) in three tertiary institutions in south-west Nigeria between January, 2010 and December , 2013. Methods A retrospective review of all cases of EPH over a 4year period was done. EPH was defined as hysterectomy performed at the time of delivery or within 24h of delivery for uncontrollable postpartum bleeding not responsive to conservative measures. Relevant information was extracted from the hospital records and operation notes. Statistical analysis was done using SPSS software version 17.0. Statistical significance was set at p<0.05. Results There were 102 EPHs performed among 39,738 deliveries within the study period, giving a rate of 2.6 per thousand deliveries. Indications were uterine rupture (44.1%), uterine atony (37.3%), morbidly adherent placenta (17.6%) and extension of caesarean section incision involving the uterine arteries (1%). Subtotal hysterectomy was performed in most cases (67.6%).Maternal case fatality rate was 11.8% and perinatal mortality rate was 55.9%. Blood transfusion, severe postoperative anaemia, wound sepsis, febrile morbidity and acute kidney injury were common morbidities associated with the procedure. Following multivariate logistic regression, the unbooked status [odds-ratio 95% CI=12.80 (1.22-133.97) p=0.03] was the only variable that significantly predicted maternal death. Conclusion The incidence of EPH from our study is high. Much more needs to be done in maternal health services, particularly provision of quality obstetric care to reduce the rates of EPH and the associated high maternal and perinatal morbidity and mortality.