Emergency peripartum hysterectomy in a Western Australian population: Ten-year retrospective case-note analysis.

Abstract

Emergency peripartum hysterectomy (EPH) is a life-saving obstetric procedure reserved for conditions where medical treatment and conservative surgery have failed. EPH is associated with significant morbidity and mortality. To examine the incidence, indications, risk factors, maternal and neonatal outcomes of EPH in a tertiary hospital in Western Australia (WA). A retrospective case-note analysis of all cases of EPH performed at King Edward Memorial Hospital in WA between the years 2006 and 2016. The incidence, indications, risk factors, maternal and neonatal outcomes were reviewed. All cases were ascertained via our hospital obstetric database. A total of 72 cases of EPH were identified among 64999 births. The incidence of EPH in WA was 1.1 per 1000 deliveries. Abnormal placentation was the main indication for EPH accounting for 66.7% of cases. Among women undergoing an EPH, 22.2% had a history of one previous caesarean section and 33.3% had two or more caesarean sections, respectively. Maternal morbidity was significant. There was one cardiac arrest secondary to hypovolaemia, and 84% of the women received blood transfusions with more than half of these women meeting the criteria for massive transfusion protocol (≥4 units of packed red cells). Urinary tract injury and venous thromboembolism were some of the other complications among our cohort of women. EPH is associated with significant morbidity. Our study identifies abnormal placentation as the leading cause of EPH.