Emergency peripartum hysterectomy: experience of a tertiary care hospital in South India

Abstract

Emergency peripartum hysterectomy (EPH) has been described as the most dramatic operation in modern obstetric practice and a marker of severe maternal morbidity and near miss mortality. In the past, the most common indications for EPH were uterine atony and uterine rupture. However, recent studies suggest that abnormal placental adherence and placenta praevia are the major indications for EPH, probably due to increase in caesarean delivery rate. The present study was conducted to know the incidence, types and the indications for EPH and maternal outcome. This was a retrospective study conducted in a tertiary care hospital in South India in June 2014. The data was obtained from the medical records department from June 2011 to May 2013. During the period of study there were 9287 deliveries and 30 peripartum hysterectomies were performed, rate of 0.32%.Age ranged from 18-439 years with majority belonging to the 26-30 years age group. Most of the patients were of low parity i.e. Para 1 or 2, while 9% of them were grand multiparous. Unbooked case accounted for 53.3% of the total cases. Most common indication for hysterectomy was placenta accreta, extensive uterine rupture and uterine atony. Among patients with rupture, 60% of cases were unbooked and brought from peripheries in unstable condition with rupture uterus. All the admitted patients with rupture had a previous caesarean section. The most common complication was febrile morbidity, anemia and bladder injury. There was one maternal mortality due to septicemic shock. The average period of hospital stay was of 12 days, ranging from 7-41 days, the maximum stay was in case of septicemia. All urinary complications encountered were in patients with placenta accreta. Effective antenatal care, enhancement of blood transfusion facilities and improvement of surgeon skills are important to reduce the morbidity associated with the procedure.