Abstract
BackgroundPeripartum hysterectomy (PRH) is the surgical removal of the uterus performed in obstetrical complications such as uncontrolled postpartum haemorrhage (PPH), unrepairable uterine rupture, and sepsis. Its incidence has increased in recent years. The objective of this study was to review all the cases of PRH in a tertiary care teaching hospital over three years (January 2017-December 2019) to determine its incidence and analyse clinico-demographic characteristics in these women.MethodAll women undergoing PRH from January 2017 to December 2019 were included in the study. Data were collected retrospectively from medical records, of patients who underwent a PRH at the time of delivery, or within 24 hours, or performed any time before discharge from the same hospitalization and obstetric event. The total number of deliveries including caesarean and vaginal deliveries were recorded. Main outcome measures were the incidence of PRH, indication for hysterectomy, management option used, maternal outcomes (PPH, bladder injury and maternal death) and fetal outcomes (stillbirth).ResultsThere were a total of 3904,4 deliveries; 27,337 vaginal and 11,697 caesarean sections in three years. A total of 50 patients underwent a PRH. The incidence of PRH in our study was 1.3 per 1,000 deliveries and 3.5/1,000 caesareans, respectively. PRH was found to be more common following cesarean sections than vaginal deliveries (odds ratio 22.86 [95% CI: 8.16 to 63.98]). Morbid adherent placenta (MAP) (n=30, 62%) was the most common indications of PRH. Seven (15%) women had PRH due to uterine rupture. Twenty-seven women of the 30 women (90%) with the MAP had a previous caesarean delivery. The case fatality rate per hysterectomy was 4%. Stillbirth rate (SBR: n=8,16%) among women having PRH was seven-fold higher than overall SBR in our country.ConclusionThere has been a rise in MAP as an indication of PRH in our study for a decade in comparison to uterine atony. Caesarean delivery is a significant risk factor for PRH. Previous caesarean section and major placenta previa were common occurring obstetric risk factors present in the MAP in our cohort. Our maternal mortality in PRH was low and the stillbirth rate was high when compared with national data.
Highlights
Stillbirth rate (SBR: n=8,16%) among women having Peripartum hysterectomy (PRH) was seven-fold higher than overall SBR in our country
Peripartum hysterectomy (PRH) is a surgical procedure performed at the time of delivery or in the immediate postpartum period, as a last resort in the treatment for severe postpartum haemorrhage (PPH), morbid adherent placenta (MAP), uterine rupture or genital sepsis and is associated with high maternal morbidity and mortality [1,2]
Our study showed MAP as the most common cause and intractable hemorrhage due to uterine atony as a second most common cause of PRH [21,22]
Summary
Peripartum hysterectomy (PRH) is a surgical procedure performed at the time of delivery or in the immediate postpartum period, as a last resort in the treatment for severe postpartum haemorrhage (PPH), morbid adherent placenta (MAP), uterine rupture or genital sepsis and is associated with high maternal morbidity and mortality [1,2]. The Maternal Mortality Ratio of India has declined from 178 in 2010-12 to 113 in 2016-18 [3] This has been consequent to an increase in institutional deliveries, timely management of obstetrical haemorrhage and early use of PRH for haemorrhage [3,4]. This has led to an increase in PRH in recent years [5,6,7]. The objective of this study was to review all the cases of PRH in a tertiary care teaching hospital over three years (January 2017-December 2019) to determine its incidence and analyse clinico-demographic characteristics in these women
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