Emergency Peripartum Hysterectomy Research Articles

Emergency Peripartum Hysterectomy (EPH): A Retrospective Study of Indications, Maternal and Perinatal Outcome in a Tertiary Care Hospital

Emergency Peripartum Hysterectomy (EPH): A Retrospective Study of Indications, Maternal and Perinatal Outcome in a Tertiary Care Hospital

Seven-year review of emergency peripartum hysterectomy in a tertiary hospital in northern Nigeria

Background: Emergency peripartum hysterectomy (EPH) is surgical removal of the uterus during childbirth or within its immediate 24 hours, a lifesaving procedure done as the last resort to control obstetric haemorrhage. Objectives: To determine the incidence, indications, and complications of peripartum hysterectomy. Methods: The study is a retrospective review of emergency peripartum hysterectomies performed at the Centre from 1st January, 2015 to 31st December, 2021. The patients’ case folders were retrieved from the medical records department and relevant information obtained using a structured data extraction format. The data was analyzed using SPSS version 26. Means, frequency, and percentages were used to present the significance of the results. Results: A total of 46 EPH were performed between January 2015 and December 2021 out of 20,832 deliveries within the same period, giving an incidence of 0.22% (2.2 per thousand deliveries). Indications were uterine rupture (78.2%), uterine atony (10.9%), abruptio placentae (4.3%), placenta previa (4.3%) and placenta accreta spectrum (2.2%). Subtotal hysterectomy was performed in most cases (39/46; 84.8%). The most common complication was intraoperative haemorrhage requiring blood transfusion (100%). Other complications included severe post-operative anaemia, wound sepsis, paralytic ileus and enterocutaneous fistula. The maternal case fatality was 4 (8.7%) and all the mortality cases were unbooked patients. Conclusion: The incidence of emergency peripartum hysterectomy is relatively low in our study and uterine rupture is the most common indication. EPH is associated with significant maternal morbidity and mortality, and this is related to booking status. Hence, enlightening women on antenatal care and hospital delivery will help in reducing maternal morbidity and mortality.

FREQUENCY OF EMERGENCY PERIPARTUM HYSTERECTOMY AND FACTORS LEADING TO IT IN PREGNANT WOMEN AT TERTIARY CARE HOSPITAL

FREQUENCY OF EMERGENCY PERIPARTUM HYSTERECTOMY AND FACTORS LEADING TO IT IN PREGNANT WOMEN AT TERTIARY CARE HOSPITAL

Lessons from Maternal Mortality in Cases of Emergency Peripartum Hysterectomy at Tertiary Hospital in Egypt (Retrospective Study)

Lessons from Maternal Mortality in Cases of Emergency Peripartum Hysterectomy at Tertiary Hospital in Egypt (Retrospective Study)

Emergency Peripartum Hysterectomy and its Outcome in a Tertiary Care Hospital in Dhaka City, Bangladesh

Introduction: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. EPH is a challanging but life saving obstetric procedure performed when medical and surgical conservative measures fail to control postpartum haemorrhage .The present study aimed to review the peripartum hysterectomies and to compare the incidence, indications and outcome of EPH. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh. Total 62 cases have taken, who had hysterectomy that was performed in Obstetric and gynaecology department of Addin Womens Medical College Hospital during the period between January 2020 and December 2022. Result: There were total of 36371 deliveries over the study period and EPH was performed in 62 cases making an incidence of 0.408. In this study 33.8% patients were between 35 to 39 years. Here 45.16% had their parity between 2nd and 3rd child. Here 61.2% had previous history of caesarean section, 24.19% had previous history of antepartum haemorrhage, 74.19% cases intrapartum operation had done. Among 62 cases of EPH 77.4% cases subtotal hysterectomy had done. Here, among 62 cases of caesarean section 35.48% had placenta accrete and 20.96% had history of placenta previa with haemorrhage and 12.9% had severe PPH due to atony of uterus. 22.5% cases had fetal outcome of still born but 32.25% baby born alive. In this study 51.6% cases patients develop haemorrhage as perioperative complication, 19.5% develop shock but 100% required blood transfusion among which 50% were in post operative period. Here 6 out of 62 cases had bladder injury, 5 patients needed relaparotomy due to haemoperitoneum caused by vaginal cuff bleeding. Mortality rate was 4.83%. Conclusion: Now a days the indication of EPH has changed from uterine atony to abnormal placentation. It is a most important obstetric surgery performed in life threatening haemorrhage. Involvement of an experienced obstetrician at an early stage of management and efforts should be taken to reduce morbidity and mortality. Sir Salimullah Med Coll J 2023; 31: 107-111

Outcome of Placenta Percreta Management by Planned Peripartum Hysterectomy in a Tertiary Level Hospital

The incidence of placenta accreta spectrum is gradually increasing due to increased rate of caesarean sections (CS). Due to torrential haemorrhage, placenta percreta is one of the main reasons for emergency peripartum hysterectomies and mostly results in subsequent maternal mortalities and morbidities. In such cases, caesarean hysterectomy leaving the placenta in situ without any separation of placenta is preferred. We observed the outcome of such patients managed with planned caesarean hysterectomy. This cross-sectional observational study was conducted at the Department of Obstetrics, Faridpur Medical College Hospital, Bangladesh. A total of 14 patients who underwent planned caesarean hysterectomy due to placenta percreta were studied. We performed delivery of the baby through upper segment transverse incision without placental separation. The umbilical cord was ligated leaving the placenta in the uterine cavity and cut margins of the uterus was closed with few interrupted sutures and then hysterectomy was performed. Among 14 cases, the mean age was 30 years, mean gestational age at the time of delivery was 36 weeks, and all had a history of one or more CS. Before operation, mean Hb% was 8.9 g/dl. A mean of 1.5 units pre-operative and 1.2 units post-operative blood transfusions was needed. Post-operative mean Hb% was 10.5 gm/dl. Half of the women were discharged on their 3rd post-operative day. None of them had serious pre- and post-operative complications. In light of our findings, we recommend managing placenta percreta by planned caesarean hysterectomy with the placenta left in situ to minimise blood loss and subsequent maternal mortality and morbidity.
 Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):80-84

Incidence and Risk Factors of Emergency Peripartum Hysterectomy

Background: Emergency peripartum hysterectomy (EPH) is a life-saving surgical surgery performed during or after childbirth to preserve the lives of women and newborns in life-threatening conditions. It is linked to high rates of maternal morbidity and mortality. This study aimed to determine the incidence and risk factors for EPH at a tertiary care maternity hospital in Jammu and Kashmir, India. Methods: Between January 2020 and December 2022, retrospective descriptive cohort research was carried out. All pregnant patients scheduled for delivery at the Obstetrics and Gynecology department of SMGS, GMC Jammu, were included in the study. Maternal demographics, medical and obstetric history, EPH indications, surgical and obstetric care, and maternal and newborn outcomes were all gathered from medical records and hospital databases. Descriptive analysis and statistical tests were performed using SPSS Statistics. Results: The study comprised 104 cases of EPH, with an incidence of 2.40/1000 deliveries. The usual maternal age at delivery was 36 years, and the median number of children was two. Previous cesarean delivery was a substantial risk factor, with at least one previous cesarean in 69.2% of cases. The most common cause of EPH, accounting for 73.0% of cases, was aberrant placentation. Less common indicators were uterine atony, uterine rupture, uterine myoma, and placental abruption. Total hysterectomy was performed in 83.3% of cases, with general anesthesia being the predominant type of anesthesia. The median estimated blood loss was 2100 mL, and intraoperative complications were observed in 29.8% of cases. No maternal deaths were reported. Conclusion: In the examined cohort, the incidence of EPH was 2.40/1000 deliveries. Abnormal placentation, including placenta previa and placenta accreta spectrum, as well as previous cesarean birth, were significant risk factors for EPH.

INCIDENCE, INDICATIONS, RISK FACTORS, AND OUTCOMES OF EMERGENCY PERIPARTUM HYSTERECTOMY WORLDWIDE: A SYSTEMATIC REVIEW

Objective: The objective of this study is to provide a comprehensive analysis of the occurrence, indications, risk factors, outcomes, and management strategies associated with emergency peripartum hysterectomy on a global scale. Additionally, this study aims to compare the outcomes of this procedure across various income situations.
 Methods: A systematic search strategy was conducted across several electronic reference databases: PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to August 3, 2023. Duplicate publications, review articles, editorials, and incomplete articles were excluded.
 Results: This study presents an updated version of a previously conducted systematic review, which was originally published in 2016. The inclusion criteria for this study encompassed reports that provided data on the occurrence of emergency peripartum hysterectomy. Emergency peripartum hysterectomy was operationally defined as the surgical extraction of the uterus due to severe obstetric problems within a period of up to 6 weeks following childbirth. The process of title and abstract screening, as well as full-text review, was conducted with Endnote data management software. Out of a total of 8,775 papers that were reviewed, a subset of 26 articles published after the year 2015 were deemed eligible for inclusion. Consequently, the overall number of studies included in the analysis amounted to 154.
 Conclusion: There are significant variations in the occurrence of emergency peripartum hysterectomy across different income contexts. Women residing in lower-income settings face an elevated likelihood of experiencing emergency peripartum hysterectomy, as well as a greater burden of associated morbidity and mortality. The incidence of emergency peripartum hysterectomy is expected to rise because to the escalating prevalence of caesarean deliveries.

Peripartum Hysterectomy among Patients Admitted to the Department of Obstetrics and Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Emergency peripartum hysterectomy is a life-saving procedure performed as an emergency procedure to control torrential bleeding and it is associated with significant maternal morbidity and mortality. There are only a few studies regarding this topic so this study guides us to monitor the trend and start appropriate policies to reduce unnecessary caesarean deliveries. The aim of this study was to find out the prevalence of peripartum hysterectomy among patients admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre. A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of the tertiary care centre. Data from 1 January 2015 to 31 December 2022 were collected between 25 January 2023 and 28 February 2023 from the hospital records. Ethical approval was obtained from the Institutional Review Committee of the same institute (Reference number: 2301241700). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 54,045 deliveries, peripartum hysterectomy was seen in 40 (0.074%) (0.05-0.10, 95% Confidence Interval). The major indication of emergency peripartum hysterectomy was abnormal placentation (placenta accreta spectrum) which was 25 (62.50%) followed by uterine atony in 13 (32.50%) of patients and uterine rupture in 2 (5%). The prevalence of peripartum hysterectomy was lower than in other studies done in similar settings. The indication for Emergency peripartum hysterectomy has changed in recent years from uterine atonicity to the morbidly adherent placenta which is due to a rise in the caesarean section rate. caesarean section; hysterectomy; placenta accreta.

Emergency Peripartum Hystrectomy and Postnatal Depression

Objective: to investigate postnatal depression after emergency peripartum hysterectomy versus controls. Material and methods: This case control study was conducted at District headquarters teaching hospital Rawalpindi between July 2020 and June 2021.We compared postnatal depression among patients who underwent emergency peripartum hysterectomy (EPH)versus control group where surgical procedures other than hysterectomy (B-Lynch, uterine artery ligation or internal iliac artery ligation) were performed. Results: A total of 88 patients were included, 44 in hysterectomy group and 44 in non hystrectomized/control group. The scores on Edinburgh post-natal depression scale were high in hysterectomy group (11.61±2.48) , compared to non hysterectomy group(6.79±2.13) which was statistically significant. ( p=0.001).Uterine atony, Placental abruption, placenta previa and accrete, were identified as main reasons for surgical intervention in both groups. Emergency peripartum hysterectomy is a traumatic birth event with serious physical, emotional and psychological consequences. It is empirical to not only screen the women in immediate postpartum period, but a long term follow up in community is required.

Indications, risk factors, and outcomes of emergency peripartum hysterectomy: A 7-year retrospective study at a tertiary center in Turkey.

To determine the incidence, indications, the risk factors, complications, maternal morbidity and mortality of emergency peripartum hysterectomy (EPH), and perinatal outcomes at a tertiary hospital, Turkey. We analyzed 71 cases of EPH from 2012 to 2019 at a tertiary hospital in a retrospective study. There were 142 control patients. There were 71 EPH out of 69,504 deliveries, for an overall incidence of 1.02 per 1000 births. The main indication for peripartum hysterectomy was abnormal placentation (67.6%), followed by uterine atony (28.1%), and uterine rupture (4.2%). Cesarean section (CS) and previous CS are major risk indicators for EPH. Other risk indicators are advanced maternal age (≥ 35 years) and multiparity. All patients with abnormal placentation had a previous CS. 93% of EPH were performed during and/or after CS, and 7% after vaginal delivery. 69% of EPH were made in total and 31% were subtotal. The three most common maternal morbidity included: wound infection and febrile morbidity (26.7%), bladder injury (16.9%), and disseminated intravascular coagulopathy (11.2%). There were no maternal deaths but perinatal mortality was 4%. The most common indication for EPH was abnormal placentation. Also, CS and previous CS are major risk factors of EPH. Other risk factors for EPH are advanced maternal age (≥ 35 years) and multiparity. Moreover, all unnecessary CS should be avoided.

Placenta Accreta Spectrum (PAS) Disorders: Lessons Learned from the Introduction of Different Management Strategies in an Australian Tertiary Hospital. Retrospective Study (2004 to 2020)

Background: Placenta accreta spectrum (PAS) disorder refers to pathologic adherence of the placenta and presents multiple perinatal challenges, accounting for between 30–50% of emergency peripartum hysterectomies. Accurate prenatal diagnosis allows multidisciplinary management and delivery at centres with experience and has been shown to improve perinatal outcomes. This study aims to analyse the results of implementing different strategies across the years on the diagnosis and management of PAS in a tertiary Australian hospital (Liverpool Hospital) including: the use of magnetic resonance imaging (MRI) and the benefits of the use of iliac artery balloons and ureteric stents. Secondary objectives include analysis of the risk factors and outcomes. Methods: Retrospective case series of 34 pregnancies complicated by PAS disorders, diagnosed between 2004 and 2020, and delivered at Liverpool Hospital. Descriptive and analytic study (with a significance level of p ≤ 0.05), approved by the Research Ethics and Governance Information System. Results: The incidence of PAS was 0.6 per 1000 deliveries. The typical risk factors (previous uterine surgeries and placenta praevia) were present in 79% of the cases. MRI was used in 39% of the cases (when ultrasound was inconclusive or placenta posterior) and was only inconclusive in 1 case. In total, 32% required emergency delivery due to haemorrhage or preterm labor. The overall complications rate was 32%. Ureteric stents were used in 44% of the cases and there were no ureteric injuries. The use of iliac balloons reduced the total blood loss (2.5 L compared to 2.8 L), however this difference was not statistically significant (p = 0.21). Conclusions: The prenatal diagnosis of PAS is essential to allow optimal perinatal management of these cases. The use of MRI appears helpful when ultrasound is inconclusive. In our study, the use of iliac balloons reduced blood loss, although this was not statistically significant, and ureteric stents appeared useful to avoid ureteric injury in the most complex cases, although the sample is very small. We hope that our study will help us improving our clinical practice.

Lived Experiences of Women after Emergency Peripartum Hysterectomy: A Qualitative study in Peshawar, Pakistan.

Background: Emergency Peripartum Hysterectomy (EPH) is a type of hysterectomy which is performed in emergency and life-threatening situations like postpartum hemorrhage. Aim: To explore the lived experiences of women after EPH. Methods: A qualitative phenomenological study was conducted in Lady Reading Hospital (LRH) Peshawar, Khyber Pakhtunkhwa (KP) to explore the lived experiences of women after EPH. A total of 10 participants were included in the study. Data were collected using interview guide, audio and written data were recorded. Thematic analysis was done using thematic analysis techniques. Results: Overall, ten participants were included in the study. 117 codes were generated from the data which helps in creating five themes about the experiences of women after EPH. The women experience profound grief, needs for support, needs for information, bonding and fear. Conclusion: The findings of the study concluded that women after EPH experience profound grief, need of support, need of information, bonding, and fear. Keywords: Women, Emergency peripartum hysterectomy, lived experiences, Qualitative Study

INCIDENCE, INDICATION AND OUTCOME OF EMERGENCY PERIPARTUM HYSTERECTOMIES IN A TERTIARY CARE HOSPITAL

BACKGROUND: Emergency peripartum hysterectomy is the life-saving procedure to control a life-threatening haemorrhage performed at the moment or within 24 hrs of delivery (caesarean or vaginal). It is linked to a substantial percentage of maternal morbidity and mortality.AIM:To estimate the incidence,indication,and outcome of emergency peripartum hysterectomy over a 1-year period in a tertiary care hospital and the leading cause of the increased no of hysterectomies in the defined time interval. MATERIAL AND METHODS: This is a prospective study done in SMGS HOSPITAL, JAMMU, a tertiary care hospital. This study included all women who underwent emergency peripartum hysterectomy over a span of 1 year (August 1,2021,to July 31,2022).Detailed review including previous obstetric history, details of index pregnancy, an indication of peripartum hysterectomy, outcome, and infant morbidity was taken into account. RESULTS: During the course of the research, there were 33 women who had undergone peripartum hysterectomy. The incidence rate was 1.8 cases per 1000 births. The predominant indications were placenta accreta (69%),Atonic PPH (Postpartum haemorrhage) (18%),and uterine rupture (9%).Emergency peripartum hysterectomies were more prevalent after caesarean section (73%) than vaginal births (27%).Previous caesarean,multiparity,any past uterine surgeries, and older age were risk factors. 48% of women needed intensive care postoperatively.The common maternal complications were bladder injury (intraop) (12%), febrile morbidity (18%), disseminated intravascular coagulation (DIC) (8%),acute kidney injury (AKI) (9%),and wound infection (10%).There were 2 maternal deaths (6%) following emergency peripartum hysterectomy. The patient's condition was taken into consideration while deciding whether a complete or partial hysterectomy would be best.CONCLUSIONS: Abnormal placentation,placenta accreta, has surpassed uterine atony as the leading cause of emergency hysterectomy during the perinatal period in recent years. The primary reason for this is the growing popularity of caesarean sections. Peripartum hysterectomies for diagnosed cases of placenta accreta with antenatal anticipation of the risk factors,a multidisciplinary approach and ICU backup had better outcomes with less morbidity.An important factor influencing the maternal outcome was the timing of the decision to perform a peripartum hysterectomy which is neither too early nor too late

Pelvic packing in the treatment of severe postpartum posthysterectomiam hemorrhage.

Pelvic packing (PP) as a simple method of ”damage control surgery” in severe abdominopelvic hemorrhage in gynecological and obstetric surgery after emergency obstetrics or gynecological hysterectomy. To present the case of successful PP as a simple and effective method in refractory pelvic bleeding after emergent peripartum hysterectomy and severe obstetric shock with consumptive coagulopathy. Acording to laboratory findings and clinical condition in a 30-year-old (G2 P2) parturient, it was most likely an obstetric embolism with uterine rupture as the cause of severe postparum hemorrhage with disseminated intravascular coagulopathy and obstetrics hemorrhagic shock development in the described case. Pelvic packing after postpartum hysterectomy was the definitive minimally invasive and simple hemostatic procedure. The use of pelvic packing and obstetrics skills should be included in the protocol as a necessary, life-saving, and uncomplicated vital indication procedure.

Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis.

To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings. PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021. Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8,775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting. The meta-analysis included 154 studies: 14,409 emergency peripartum hysterectomies were performed in 17,127,499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1,000 births (95% CI 1.0-1.3). The highest incidence was observed in lower middle-income settings (3/1,000 births, 95% CI 2.5-3.5), and the lowest incidence was observed in high-income settings (0.7/1,000 births, 95% CI 0.5-0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9-42.4), uterine atony (27.0%, 95% CI 24.6-29.5), and uterine rupture (21.2%, 95% CI 17.8-25.0). In lower middle-income countries, uterine rupture (44.5%, 95% CI 36.6-52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5-53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2,706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3-81.9). The most common complications were febrile (29.7%, 95% CI 25.4-34.3) and hematologic (27.5%, 95% CI 20.4-35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5-4.2) and was higher in lower middle-income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9-14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6-1.6). Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.

A study of frequency, indication and maternal outcome in emergency peripartum hysterectomy in a tertiary care hospital

Antepartum and postpartum haemorrhage are life threatening condition. Obstetric haemorrhage often ends with Peripartum hysterectomy which is done to save the mother if medical and conservative surgical management fails. This study was done to analyse the frequency, indications and associated complications of peripartum hysterectomy. This retrospective study is conducted in the Department of Obstetrics and Gynecology, Government Medical College Hospital, Kallakurichi, Tamil Nadu, over a period of one year from March 2021 to February 2022.: Total mothers delivered during the study period was 8174. Emergency peripartum hysterectomy was performed in 28 women. Incidence of peripartum hysterectomy is 3.42/1000 deliveries (0.34%). Most were in the age group of 21-30 years. Majority of patients were multigravida. Most common cause for peripartum hysterectomy was atonic postpartum haemorrhage. Most common postoperative complication was post operative febrile illness.Peripartum Hysterectomy for control of obstetric haemorrhage is a lifesaving procedure, However it is usually associated with significant morbidity and mortality. This can be reduced by effective antenatal care, tracking of high risk mothers and reduction of primary caesarean delivery as it has significant impact women’s child bearing and reproductive life.

Incidence, indications, and maternal outcomes of emergency peripartum hysterectomy at a tertiary hospital in Ethiopia: Aretrospective review.

To determine the incidence, indications, and maternal outcomes of emergency peripartum hysterectomy (EPH) at a tertiary setting in Ethiopia. A 4-year retrospective review of EPH cases was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from January 2016 to December 2019. Data were collected by reviewing maternal charts of EPH cases using a structured data extraction format. Stata Statistical Software, release 14, was used for data analysis. Frequency and percentages are used to present the significance of results. Among 39 629 deliveries during the study period, there were 105 EPH, making the incidence rate 2.6 per 1000 deliveries. The common indications for EPH were uterine rupture (63/105; 60%), intractable uterine atony (23/105; 21.9%), and placenta accreta spectrum (14/105; 14.7%). The most common complications were anemia (85/105; 80.9%), puerperal fever (13/105; 12.4%), acute kidney injury (10/105; 9.5%), and relaparotomy (7/105; 6.7%). The incidence of EPH observed in our institution is high. Appropriate patient selection for vaginal delivery and strict labor follow up with early intervention for labor abnormalities should be the guiding principles of optimal obstetrical care to alleviate the burden of uterine rupture.

Emergency Peripartum Hysterectomy at Sultan Qaboos University Hospital in Oman. Nine years’ study

Objective: To study risk factors, incidence, indications, maternal and perinatal complications of women who underwent emergency peripartum hysterectomy (EPH) at Sultan Qaboos University Hospital (SQUH) in Oman.
 Method: This is a retrospective study, in which all cases EPH performed at SQUH between January 2007 and December 2016 were reviewed.
 Results: During the 9 years study period, there were 18 cases of EPH; the total number of deliveries during the same period was 32,963, so the incidence of EPH was 0.55 per 1,000 deliveries. Of all cases of EPH, 13 cases (72.2%) were cesarean hysterectomy compared with 5 cases (27.8%) were postpartum hysterectomy. Twelve cases (66.7%) were total hysterectomy while 6 cases (33.3%) were subtotal hysterectomy. The most common risk factor for EPH was placenta previa and accrete with previous cesarean section (CS) (27.6%); followed by previous CS without placenta previa (24.1%). The most common indication for EPH was placenta previa and accreta (44.4%), and previous CS (16.7%). During the study period, there was only one case of maternal death (5.6%). There were no cases of stillbirths or early neonatal deaths. There were 4 cases of bladder injury (22.2%). Women aged between 35-34 years and para > 5 had the highest incidence of EPH (50.0%).
 Conclusion: To reduce the incidence of EPH and its catastrophic consequences, we need to identify high-risk cases ante-natally and potential cases for EPH should be booked early during pregnancy and managed during pregnancy and delivery at a tertiary hospital by an experienced team.

Indications of Peripartum Hysterectomy

Introduction: Peripartum hysterectomy has to be done repeatedly as the last resort in saving a woman's existence. Currently, several drugs and surgical techniques have been established for the management of postpartum haemorrhages. The foremost indication for peripartum hysterectomy is severe uterine haemorrhage that cannot be controlled by conservative methods. Objectives: This study intended to find out the indication and frequency of peripartum hysterectomy in MAG Osmani Medical College Hospital, Sylhet. Methods: This prospective cross-sectional study on 100 cases of peripartum hysterectomy was carried out at the Department of Obstetrics & Gynaecology at Sylhet M.A.G Osmani Medical College Hospital, Sylhet from January 2004 to June 2005. Verbal consent was taken before recruiting the study population. Data was compiled and analysed manually. Result: The commonest age group involved in peripartum hysterectomy was 31-35 years (38,38.0%). The incidence of peripartum hysterectomy was 0.70%. Rupture uterus (76%) was the most common cause. Other causes are uterine atony (12%), Placenta praevia (2%), placenta accreta (2%) & sepsis in 6% of cases. Maximum patients (82,82.0%) did not get any antenatal care. Of those who got antenatal care, eighteen patients (18,18.0%) were irregularly booked. Conclusion: Emergency peripartum hysterectomy is a vital lifesaving technique and remains to have a high incidence in our community. The choice to implement an emergency peripartum hysterectomy is usually obscure as the obstetrician's paramount wish is to preserve the uterus for future childbearing.