English

Abstract

OBJECTIVE: To determine the incidence, indications, maternal and perinatal outcome of emergency peripartum hysterectomy. METHOD: A prospective observational study of all patients who underwent peripartum hysterectomy was conducted from June 2011 to November 2012 in the Department of Obstetrics and Gynecology, Lalla Ded Hospital, an associated hospital of Government Medical College, Srinagar, Kashmir. Data, specifically on the incidence of emergency peripartum hysterectomy, the total number of deliveries, the maternal parameters, the indications of peripartum hysterectomy and associated maternal morbidity and mortality were recorded on a proforma. RESULTS: There were 87 cases of peripartum hysterectomy (75 caesarean hysterectomies, 86.2% and 12 postpartum hysterectomies, 13.8%), making an incidence of 2.56/1000 deliveries. Most of the patients were para 3, 32 (36.8%), were mostly in age group of 35-39 years 38 (43.7%) and belonged to rural areas. Overall, the most common indication for emergency peripartum hysterectomy was morbidly adherent placenta with placenta previa 39(44.8%) followed by uterine rupture 24 (27.6%), uterine atony 13 (14.9%) and accidental haemorrhage 6 (6.9%). In 38 (43.7%) patients total abdominal hysterectomy was performed while 49 (56.3%) patients required subtotal hysterectomy. There were 9 (10.3%) maternal and 40 (46%) perinatal deaths; all were due to severity of conditions necessitating hysterectomy. CONCLUSION: Emergency peripartum hysterectomy is potentially a lifesaving procedure associated with significant maternal morbidity and mortality. Morbidly adherent placenta with placenta previa was the commonest indication for emergency peripartum hysterectomy. Previous scar, multiparity and abnormal placentation were the significant risk factors.