Assessment of the Cases Undergone Peripartum Hysterectomy in a Tertiary Care Hospital in the Last Three Years

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DOI: 10.4236/ojog.2018.811101    1,078 Downloads   2,243 Views  
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ABSTRACT

Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & complications of peripartum hysterecomty performed in a tertiary care hospital & compare the results with other reports in the literature. Methods: Twenty nine peripartum hysterectomy cases carried out between July 2015 and June 2018 in Enam Medical College & Hospital, Savar, Dhaka were evaluated retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results: Peripartum hysterectomy incidence was found as 7.26 per 1000 deliveries. The most common indication for hysterectomy was placenta previa with morbidly adherent placenta (17/29) followed by post-partum haemorrhage due to uterine atony (6/29) and ruptured uterus (6/29). There were 6 cases of intraoperative bladder injury. We had 5 maternal deaths, 3 of them were due to irreversible shock & 2 due to septicaemia. There were 5 cases of neonatal mortality mostly because of prematurity & asphyxia. All of the placenta previa with placenta accreta cases had at least one previous cesarean section. All 6 ruptured uterus cases had history of previous caesarean section. It was found that blood transfusion was required in all cases. Conclusion: Obstetric hemorrhages are life-threatening clinical conditions & peripartum hysterectomy is a necessary life-saving procedure. Abnormal placentation is the leading cause of emergency peripartum hysterectomy specially in cases with previous cesarean section history.

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Sayma, A. and Ara, G. (2018) Assessment of the Cases Undergone Peripartum Hysterectomy in a Tertiary Care Hospital in the Last Three Years. Open Journal of Obstetrics and Gynecology, 8, 1006-1014. doi: 10.4236/ojog.2018.811101.
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