Incidence Of Emergency Peripartum Hysterectomy Research Articles

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.

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.

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.

Development of a Nomogram for Preoperative Prediction of Emergency Peripartum Hysterectomy with Postpartum Haemorrhage: A Chinese-Population-Based Study

Objective: To develop and validate a model to predict the incidence of emergency peripartum hysterectomy (EPH) due to postpartum haemorrhage (PPH) from the time of delivery to 6 weeks postpartumin the duration of caesarean section (C-section). Methods: There were 627 patients with PPH including in this retrospective study from 2015 to 2019. Among these patients, 439 patients were divided into the model development group and 188 patients were divided into the validation group. The validation group was constructed for external validation in the usage of bootstrap resampling. The least absolute shrinkage and selection operator (LASSO) regression model was used to reduce the data dimension, and select features and independent risk factors. Results: In total, the incidence rate of PPH and EPH was 7.53% (2145/284,912) and 2.73‰ (78/28,491) among the 28,491 patients with C-section, respectively. The results of LASSO regression indicated that prothrombin time decrease at 60 minutes after C-section (odds ratio (OR) = 1.823, 95% confidence interval (CI): 1.171–2.839) and placenta previa (OR = 5.374, 95% CI: 2.751–10.393) were positively associated with EPH in this study, while gestational age at termination (OR = 0.959, 95% CI: 0.930–0.989) and albumin decrease at 60 minutes after C-section (OR = 0.907, 95% CI: 0.843–0.976) had negative association with EPH. Besides, we found that the C-index was 0.896 for the primary cohort and 0.899 for the validation cohort in the prediction nomogram, respectively. Conclusions: In this retrospective study, an EPH nomogram within several risk factors, which was constructed by LASSO regression, can be contributed to effectively predict the risk of EPH in patients with PPH during C-section. In addition, a significant association is observed between abnormal placenta and peripartum hysterectomy.

Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania.

Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.

Emergency peripartum hysterectomy: Five-year experience in a university hospital

Background/Aim: Postpartum hemorrhage (PPH) is an important cause of maternal death and morbidity worldwide. Its incidence is still increasing in some countries. This study aimed to evaluate the incidence, indications, risk factors, complications, maternal and fetal outcomes, mortality rates and management strategies of emergency peripartum hysterectomy (EPH) in women with life-threatening postpartum hemorrhage. Methods: This retrospective cohort study included 94 cases of EPH performed at tertiary obstetric center between January 2016-January 2021. The demographic data, current pregnancy and delivery mode, hysterectomy indications, operative complications, postoperative conditions, and maternal and fetal outcomes were analyzed. EPH was performed for hemorrhage which cannot be controlled with other conventional treatments within 24 hours of delivery. Results: The incidence of EPH was 1.71 per 1000 deliveries. In our study, the indications of hysterectomy were placenta previa in 47 cases (50%), placental insertion anomalies in 23 cases (24.5%), uterine atony in 22 cases (23.4%), and uterine rupture in 2 cases (2.1%). Hysterectomy was performed after vaginal delivery in 7 patients (7.4%) and during cesarean section in 87 cases (92.6%). Total and subtotal hysterectomy were performed in 88 (93.6%) and 6 cases (6.4%), respectively. Major complications occurred in 40 patients (42.6%). In total, 97.9% of the patients required a transfusion of blood and blood products. The mean postoperative hospital stay was 8.1 (6.1) days. There were two (2.2 %) maternal deaths due to pulmonary embolism and coagulopathy. Conclusion: EPH operation has high maternal morbidity and mortality but is lifesaving when performed at the appropriate time. The most common indication for EPH was placental abnormality (74.5%), followed by uterine atony (23.4%). Together with a significant increase in cesarean rates, significant increases in the frequency of placental abnormalities are remarkable. Limiting the number of cesarean deliveries will have a significant impact on reducing the risk of EPH.

PERIPARTUM HYSTERECTOMY AND ITS RISK FACTORS

Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy.
 Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts.
 Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded.
 Conclusions: The timely intervention improves the outcome in Peripar­tum Hysterectomy, which is frequently associated with abnormal placen­tation as a consequence of increasing caesarean deliveries rate.

Emergency peripartum hysterectomy in a tertiary teaching hospital in Northern Jordan: a 15-year review

Emergency peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum hemorrhage. It is associated with a high rate of maternal morbidity among survivors. This work aims to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over 15 years. A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormally adherent placenta were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The chi-square test, Fisher’s exact, and independent sample T test were used for analysis. Statistical significance was declared at α < 0.05. The incidence of peripartum hysterectomy was 1.38 per 1000 births. Fifty-nine were performed after cesarean section and three were performed after vaginal delivery (P<0.001). Abnormally adherent placenta (accreta, increta, and percreta) was the main indication (44.06%). The strongest risk factor for abnormally adherent placenta was placenta previa with previous cesarean section (P=0.001, OR 16.25, 95% CI 1.95-135.01). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (27.11%). No difference in morbidity was noted between total and subtotal hysterectomy. The incidence of emergency peripartum hysterectomy is increasing steadily over the last two decades in the north of Jordan. Abnormally adherent placenta is the most common indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications’ development, admission to the intensive care unit, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant.

Emergency Peripartum Hysterectomy at a Tertiary Care Hospital: A Five Year Analysis

Aims: To analyze the medical records of emergency peripartum hysterectomy in a teaching hospital&#x0D; Methods: A hospital based descriptive cross-sectional study was carried out on emergency peripartum hysterectomy at National Medical College and Teaching Hospital, Birgunj, Nepal from July 2011 to July 2016. Data were collected from the medical record.&#x0D; Results: There were 29 maternal survivors out of 33 cases of emergency peripartum hysterectomy, among which 21 cases were of subtotal and rest 11 had undergone total hysterectomy. The incidence of emergency peripartum hysterectomy was found out to be 0.2%. Most of the women who had undergone hysterectomy were of high parity (≥4) and advanced maternal age. Mean age of hysterectomy was 27 years. Major indications for hysterectomy were uterine rupture (n=13, 40%) followed by uterine atony (n=11, 33%), placental complications (n=8, 24%) and uterine inversion (n=1, 3%). Three-fourth of women who underwent hysterectomy for placental complications had history of previous caesarean section. Emergency peripartum hysterectomy following caesarean section was 19 (57.6%) and the rest 14 (42.4%) had delivered vaginally. Twenty-six women (79%) were referred-in cases.&#x0D; Conclusions: Majority (88%) of peripartum hysterectomies were maternal near-miss and resulted in mortality of 12%. Uterine rupture and atony constituted almost three-fourth of cases and emergency procedure was in rising trend each year over five years of record.&#x0D; Keywords: caesarean section, peripartum hysterectomy, postpartum haemorrhage

Peripartum hysterectomy and its risk factors

Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy. &#x0D; Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts. &#x0D; Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded. &#x0D; Conclusions: The timely intervention improves the outcome in Peripar­tum Hysterectomy, which is frequently associated with abnormal placen­tation as a consequence of increasing caesarean deliveries rate.

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

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.

Emergency peripartum hysterectomy: our experience.

To investigate the incidence of and reasons for emergency peripartum hysterectomy (EPH) between 2009 and 2013 in our hospital, one of the three hospitals with the highest rates of delivery in Turkey. A retrospective study. Seventy-six peripartum hysterectomies were evaluated. We compared the modes of delivery and examined whether bilateral internal iliac artery ligation was performed. The incidence of EPH was 0.77 in 1000. The majority of cases involved multiparity, uterine rupture, placenta praevia, or placental invasion abnormalities. The most frequent reason for EPH was uterine atony (64.5%). There was no statistically significant relationship with mode of delivery; however, the complication rate and requirement for fresh frozen plasma were significantly (p<0.01) related to whether bilateral internal iliac artery ligation was performed. Uterine atony was the most common indication for EPH. The most important step to avoid performing EPH is to calculate patients' risks for postpartum bleeding. Postpartum haemorrhage may not be preventable, but when it happens, obstetricians must be prepared to perform EPH, and in high-risk patients, to perform internal iliac artery ligation.

Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review.

Our objective was to determine the incidence and mortality rates associated with emergency peripartum hysterectomy, factors that lead to uncontrolled hemorrhage and emergency peripartum hysterectomy, and to determine the relationship between cesarean section and risk of emergency peripartum hysterectomy. Studies published between January 1, 2000 and December 31, 2012 were identified using PubMed, OVID and Web of Science databases. Studies were included if they reported incidence rates for emergency peripartum hysterectomy, factors that lead to hemorrhage and emergency peripartum hysterectomy, or the association of emergency peripartum hysterectomy with cesarean section in high-income countries. Four hundred and fifty-one studies were identified, and 52 were included. The incidence of emergency peripartum hysterectomy ranged from 0.20 to 5.09 per 1000 deliveries with a median incidence rate of 0.61 per 1000 deliveries. These rates have increased over time. Rates varied by region/country, specifically with the United States reporting higher rates than North American, Asian, Oceania, and European countries. The most common factor leading to emergency peripartum hysterectomy was placental abnormalities. Both cesarean section and prior cesarean section were strong risk factors for emergency peripartum hysterectomy with higher risks conferred for each additional cesarean section. The mean percentage of maternal deaths for EPH survivors was 3.0 %. Given the association of cesarean section with emergency peripartum hysterectomy, the increased risk of emergency peripartum hysterectomy should be factored into the decision of whether to proceed with cesarean delivery, particularly for women who desire more children.

English

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.

Clinical analysis of emergency peripartum hysterectomies in a tertiary center

Objective: To investigate the incidence, indications, complications, and risk factors associated with increased mortality and morbidity of emergency peripartum hysterectomy (EPH). Materials and Methods: The authors retrospectively analyzed 48 cases of EPH performed within six-year interval at Ondokuz May&#x0131;s University Hospital. EPH was defined as the operation performed for life-threatening hemorrhage which could not be controlled with conservative treatment modalities within 24 hours of a delivery. Results: The incidence of EPH was 5.03 per 1,000 deliveries. The most common indication for EPH was abnormal placental adherence (n = 22, 45.8%), followed by uterine atony (n = 19, 39.6%). All the patients with placenta accreta had a history of repeat cesarian section (CS) and placenta previa. Total hysterectomy was performed in almost all of the patients (n = 47, 97.9%). All women required blood transfusions. Maternal morbidity was significant, with bladder injury (31.3%) and disseminated intravascular coagulation (18.7%) among the most common complications. There were one maternal (2.1%) and five neonatal deaths (10.4%). Conclusion: Since most of the EPH cases are associated with prior cesarean delivery, decision of the first CS should be made for true obstetrical indications. If conservative treatments fail to control massive obstetrical bleeding, blood products and an experienced obstetrician should be ready to perform EPH to decrease the maternal morbidity and mortality.

Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study.

To estimate the incidence of emergency peripartum hysterectomy over 6 years in Ain-shams University Maternity Hospital. Detailed chart review of all cases of emergency peripartum hysterectomy, 2003-2008, including previous obstetric history, details of the index pregnancy, indications for emergency peripartum hysterectomy, outcome of the hysterectomy and infant morbidity. The overall rate of emergency peripartum hysterectomy was 149 of 66,306 or 2.24 per 1,000 deliveries. The primary indications for hysterectomies were placenta accreta/increta 59 (39.6 %), uterine atony 37 (24.8 %), uterine rupture 35 (23.5 %) and placenta previa without accreta 18 (12.1 %). After hysterectomy, 115 (77 %) women were admitted to the intensive care unit. Women were discharged home after a mean 11.2 day length of stay. Using multifactorial logistic regression analysis, we found that woman's age, atonic uterus, placenta accreta/increta, previous cesarian section and ruptured uterus were independent predictors for peripartum hysterectomy Abnormal placentation was the main indication for peripartum hysterectomy. The risk factors for peripartum hysterectomy were morbid adherence of placentae in scared uteri, uterine atony and uterine rupture. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk. The risk of peripartum hysterectomy seems to be significantly decreased by limiting the number of cesarean section deliveries, thus reducing the occurrence of abnormal placentation in the form of placenta accreta, increta or percreta.

Emergency peripartum hysterectomy: our 12-year experience

The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH). We analyzed retrospectively 44 cases of EPH performed at tertiary obstetric center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH, and postoperative follow-up were obtained by analyses of hospital records. The overall incidence of EPH was 0.48 per 1,000 deliveries during the study period. The most common indications of EPH were abnormal placentation (50 %), uterine atony (36 %) and uterine rupture (9 %). All patients who underwent EPH with abnormal placentation had one or more previous cesarean sections (CS) except one. In our series, 24 cases (54 %) underwent total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %), whereas subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %). Maternal mortality was seen in 2 patients (4.5 %). The causes were disseminated intravascular coagulation in one and adult respiratory distress syndrome in the other patient. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4 and prematurity in 3 patients. In our series, abnormal placentation was the most common indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.

Maternal Near Miss Review: A Way Forward

Maternal Near Miss Review: A Way Forward

Emergency Peripartum Hysterectomy: A one year review at a tertiary care hospital

Background: Emergency Peripartum Hysterectomy (EPH) is a lifesaving surgical procedure. The higher incidence of EPH in developing countries is because of the higher prevalence of risk factors of primary postpartum haemorrhage like, multiple pregnancy, grandmultiparity, cephalo-pelvic disproportion and prolonged obstructed labor/uterine rupture, previous caesarean section. The increasing incidence of the procedure in developed countries has been attributed to the increasing caesarean section rate which predisposes to placenta previa. Aims & Objective: To estimate the incidence, indications and complications associated with peripartum hysterectomy performed at a tertiary care hospital. Material and Methods: The retrospective observational analytical study was conducted at the Department of Obstetrics and Gynecology, Lady Goshen hospital, Mangalore from January 2012 to December 2012. Records of all patients who had undergone peripartum hysterectomy during the study period were explored for age, parity, booking status, indication and the type of operation performed. Maternal morbidity and mortality were also recorded. Results: During the study period there were 5497 deliveries, out of which 6 women had undergone an EPH. The incidence was 1.2/1000 deliveries. The main indication was uterine atony 4 (66.7%), followed by rupture uterus 1 (16.7%) and placenta previa with placenta accreta 1 (16.7%). Maternal complications included febrile illness (50%) and anaemia (33.3%). All women, 6 (100%) required blood transfusions, 2(33.3%) cases transferred to ICU. No maternal deaths occurred. Conclusion: The leading indications for emergency peripartum hysterectomy in our study are uterine atony, placenta previa with placenta accreta and uterine rupture. The higher incidence of emergency peripartum hysterectomy is because of the higher prevalence of risk factors like multiparity, previous caesarean section and cesarean section in the index pregnancy. Proper antenatal care, early identification of risk factors and timely intervention by an obstetrician are necessary in preventing this disastrous event.

Emergency Peripartum Hysterectomy: A Retrospective Study at a Tertiary Care Hospital in Karnataka

Objectives: The main objectives of this study were to determine the incidence, maternal characteristics, indications, the maternal and perinatal outcomes at J.J.M. Medical College, Teaching Hospital, Davangere, Karnataka, India Materials and method: This is a retrospective descriptive study done in the maternity unit of the J.J.M. Medical College Teaching Hospital, Davangere, Karnataka, India. From June 2009 to June 2011. Results: The incidence of peripartum hysterectomy during the study period was 1.0/1000 deliveries. The main indication was uterine atony 15(60%) ,severe uterine bleeding from uterine rupture 8 (32%), placenta accreta 2 (8%) and all patients received blood transfusion. 62.5% of women belonged to the 26-30 year age group and 31% belonged to the 20-25 year age group. There were 4 mortalities (8%) one patient died on 4th post-op day due to acute renal failure and the other died 2 hours after surgery due to cardiac arrest.2 died secondary to DIC. Average hospital stay of the patients was 9 days. Perinatal loss occurred in 14 cases (56%), majority due to pulmonary haemorrhage and prematurity. Conclusions: The incidence of emergency peripartum hysterectomy is high. It is performed for young nulliparous women to elderly grand-multiparous women. The surgery is associated with significant maternal and perinatal morbidity and mortality. Timely expert management in a well resourced centre is advocated.