Abstract
The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period. We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.
Highlights
The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage
Our study documented that postpartum hysterectomy is associated with previous caesarean section with placenta previa, resulting in abnormal placentation that was difficult to remove after delivery of fetus during caesarean delivery (CS)
Since any woman can suffer from postpartum hemorrhage (PPH), our study revealed that additional indications for Emergency peripartum hysterectomy (EPH), such as premature rupture of membrane (PROM) (6/61), abruptio placenta (4/61), multiple fibroid, gestational diabetes mellitus (GDM) (5/61) and multifetal pregnancy (4/61), scar pregnancy (2/61), rupture uterus (2/61), and very rarely broad ligament hematoma (1/61), presumably makes it more likely
Summary
The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. Emergency peripartum hysterectomy (EPH) is defined as irretrievable removal of uterus performed after 20 weeks of gestation for intractable uterine bleeding not responsive to conservative measures occurring at any time after child birth but within the first six weeks postpartum. Pradhan et al Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications. The study attempted to identify the independent high risk factors related to peripartum emergency hysterectomy, incidences, and complications. We researched for alternative treatment for severe postpartum hemorrhage to prevent or minimize the increasing rate of EPH and preserve future fertility.
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