Emergency peripartum hysterectomy: The experience of a tertiary referral hospital

Abstract

Objective(s): The aim of this study was to review the frequency, indication, associated risk factors, rates of maternal morbidity and mortality as well as neonatal outcome after emergency peripartum hysterectomy at a tertiary care referral hospital. Study design: A retrospective observational study carried out from November 2008 to 2011. Patients and methods: The study comprised of 29 patients at Mansoura University Hospitals a tertiary referral hospital Egypt. Frequency, indications, associated risk factors and maternal morbidity and mortality were reported as well as neonatal survival and outcome. Results: The frequency of emergency peripartum hysterectomy in our study period was (29/10000 deliveries = 0.29%) and the mean age and parity of the patients were 36.4 ± 8.9 years and 2.9 ± 1.56 respectively. The mean gestational age at the time of delivery was 35.45 ± 2.9 weeks. Twenty-five patients (86.2%) had a history of previous cesarean delivery(ies) meanwhile the others (4/29 = 13.8%) had vaginal delivery(ies). Abnormally adherent placenta and severe postpartum hemorrhage were the main indication for the procedure (11/29 = 37.9%). Other indications included rupture uterus (7/29 = 24.1%), severe uterine atony (7/29 = 24.1%), multiple uterine fibroid (3/29 = 10.3%) and 1 case with severe uterine infection (1/29 = 3.4%). All women received blood transfusion, 5 cases (17.2%) required intensive care unit admission, and 3 cases (10.3%) developed intraoperative arrest, 5 patients (17.2%) had urinary bladder injuries and 2 cases (6.8%) had wound infection. The maternal mortality occurred in 4 cases (13.8%) while overall neonatal survival rate was 86.2% (25/29). Conclusion: Emergency peripartum hysterectomy is still high in our locality representing a significant risk for the mother and the baby; hence health care authorities should raise the problem to decrease this burden