Maternal Outcome in Emergency Peripartum Hysterectomy: Minimizing the Risks

Abstract

ABSTRACT Objective To study the incidence, causes and maternal outcome in emergency peripartum hysterectomy. Materials and methods Retrospective, descriptive study of emergency peripartum hysterectomy by analyzing the labor records of patients undergoing the procedure in the past 5 years. Results There were 57 emergency hysterectomies among the 28940 deliveries, over the past 5 years. The incidence of EPH was 1.97 per 1000 deliveries. The mean age of the patients was 35.03 ± 5.9 (range: 21-47) years. Mean parity was 4.8 ± 2.8 (range: 0-13). Of 57 patients, 50 (87.7%) patients had previous history of cesarean section (CS). The main indications for hysterectomy were placental abnormalities 63.1% (OR = 1.54; 95% CI = 9.5-13.34, p-value <0.001) and uterine atony 24.5% (OR = 1.42; 95% CI = 7.43-15.43, p-value <0.001). Subtotal hysterectomy was performed in majority 50 (87.7%) of the cases. Bladder injury was the significant intraoperative complication in 17 (30%) cases (OR = 1.87; 95% CI = 9.45- 18.97, p-value <0.001) with no residual damage. Infections were the commonest complication seen in 15 (26%) patients postoperatively. The maternal mortality occurred in 2 (3.5%) patients. Conclusion Emergency peripartum hysterectomy, though uncommon, remains a challenging but life saving procedure in obstetrics. Its indications in modern obstetrics are changing and still emerging. Abnormal placentation, previous CS, multiparity are important risk factors. Antenatal diagnosis of low lying and adherent placenta, minimizing the CS rate, proper and timely management of third stage of labor and emergency preparedness are imperative to minimize the chances of emergency peripartum hysterectomy and improving the outcome. How to cite this article Zia S, Rafique M, Rizwan A, Khan T, Al-Shamrani A. Maternal Outcome in Emergency Peripartum Hysterectomy: Minimizing the Risks. J South Asian Feder Obst Gynae 2013;5(3):91-95.