Incidence and causes of Peripartum Hysterectomy – A Prospective study

Abstract

Background: Peripartum hysterectomy is a major surgery performed as a life-saving procedure in cases of severe intractable obstetric haemorrhage. Objectives: The objectives of this study are to estimate the incidence, causes [indications], risk factors, surgical complications and post-operative complications, maternal and perinatal outcome
associated with peripartum hysterectomy in a tertiary referral and teaching hospital. This would help highlight the lack of availability and utilization of antenatal services, identifies avoidable factors and stresses the need to organize health care services to improve the maternal and fetal outcome. Methodology: It is a prospective descriptive study conducted at Modern Government Maternity Hospital, Osmania medical college, Hyderabad. The study was conducted from july 2013 to june 2015. During the 2 year study period all the patients who underwent peripartum hysterectomy were included in the study. Results: The total number of deliveries during the study period was 32,066. Number of peripartum hysterectomies were 58. Incidence of peripartum hysterectomies was 1.81 per 1000 deliveries. Among the women who underwent peripartum hysterectomy majority belonged to the age group 26-30 years [55.17%], parity(multiparous)-(87.94%), low socio economic status (53.45%), referred (51.72%). The most common indication being abnormal placentation/ morbidly adherent placenta (43.10%) followed by rupture uterus (36.21%). The commonest risk factor was previous cesarean section (72.40%). Average blood loss is 2275ml. All the women in the study required transfusion of blood. Incidence of bladder injury 18.96%. Average hospital stay was 15 days. Re-laparotomy was done in 1 case. Disseminated intravascular coagulation [DIC] -1 case. There were 3 maternal deaths. Perinatal deaths in 62.06%.Conclusion: Improving the quality of antenatal care, identification of high risk cases and timely interference and early referral to tertiary centre, improving health education, motivation for sterilization procedure during repeat LSCS,availability of blood and blood products, and multi-disciplinary approach reduces the morbidity and mortality resulting from peripartum hysterectomy.