EMERGENCY PERI PARTUM HYSTERECTOMY-A LIFE SAVING PROCEDURE

Authors

  • Anisa Fawad
  • Humaira Naz
  • Talat Nelofar
  • Aziz -un-Nisa Abbasi

Abstract

Background: Sub-total abdominal hysterectomy is a surgical procedure in which body of the uterus is removed while ovaries and cervix are preserved. The study was done with the objectives of assessing the frequency of peripartum hysterectomies, common indications and risk factors associated with this surgery. The postoperative complications including the severity of anaemia in these patients and need for blood transfusion and use of blood products like fresh frozen plasma and platelet concentrates were also studied. Methods: The study was based on the review of the records of Gynae ‘A’ Unit, Ayub Teaching Hospital, Abbottabad from January 2011 till December 2012. Data was collected from the unit record and patient’s personal files. All the patients who underwent emergency peripartum hysterectomy were included in the study. Results: During this study period there were 6535 total deliveries in the unit, 2153 vaginal deliveries and 1786 caesarean sections. Emergency perpartum hysterectomy was needed in 72 patients. In the majority of the patients the gestational age was at term. The commonest indications for this operation was haemorrhage (placental abruption) 26 patients (36% ) followed by ruptured uterus in 18 patients (25%), prolonged and obstructed labour promoted uterine atony needing hysterectomy in 13 patients (18%). Placenta previa major degree needed hysterectomy in 9 patients (12.5%) while placenta increta and chorioamnionitis each accounted for 3 cases (4.2%). At admission the majority of the patients were severely anaemic 31 patients (43.05%). The most important risk factor identified was hypertensive disorders of pregnancy 26 patients (36%), followed by uterine atony in 13 patients (18.05%). Conclusion: High risk obstetric patients, prone to peripartum hysterectomy, should be identified by health personnel working in the rural areas and should be timely referred to the hospitals where appropriate facilities are available for the management of such patients.Keywords: Peripartum hysterectomy, Sub-total abdominal hysterectomy, placental abruption

References

Larry C, Gilstrap III F, Cunningham G, Van dorten JP. Obstetric Hysterectomy. In: operative obstetrics, 2nd edition. New York: Mc Graw Hill; 1995. P 275–291.

Javaid S, Yasmin T, Rafique S, Malik S. Postpartum and Emergency Caesarean hysterectomy. Pak J Med Health Sci. 2011;5(2):239.

Javaid N, Tahir S. Emergency Obstetric Hysterectomy. One year review at Allied Hospital, Faisalabad. APMC 2010;4(1):86–9.

Nisar N, Sohoo NA. Emergency Peripartum Hysterectomy: frequency, indications and maternal outcome. J Ayub Med Coll Abbottabad 2009;21(1):48–51.

Siddique N, Ghazi A, Jabbar S, Ali T. Emergency Obstetrical hysterectomy (EOH): A life saving procedure in obstetrics. Pak J Surg 2007;23(3):217–9.

Fatima M, Kasi PM, Baloch SN, Afghan AK. Experience of Emergency Peripartum Hysterectomy at a Tertiary Care Hospital in Quetta, Pakistan. ISRN Obstet Gynecol 2011;854202.

Selo-Ojeme D O, Bhattacharjee P, Izuwa-Njoku N F, Kadir R A. Emergency Peripartum Hysterectomy in a Tertiary London Hospital. Arch Gynecol Obstet 2005;271(2):154–9.

Yamani Zamzami TY. Indications of Emergency Peripartum Hysterectomy: A review of 17 cases. Arch Gynecol Obstet 2003;268:131–5.

Karayacin R, Ozcan S, Ozyer S, Mollamahmutoğlu L, Danışman N. Emergency Peripartum Hystrectomy. Arch Gynecol Obstet 2011;283:723–7.

Awan N, Bennett MJ, Walter WA. Emergency Peripartum Hysterectomy: A 10 years review at the Royal Hospital for Women, Sydney. Aust NZ J Obstet Gynaecol 2011;51(3):210–5.

Muench MV, Baschat AA, Oyelese Y. Gravid hysterectomy: a decade of experience at an academic referral Centre. J Reprod Med 2008;53(4):271–8.

Selo Ojeme Do, Bhattacharjee P, Izuwa–Njoku NF, Kadir RA. Emergency Peripartum Hysterectomy in a Tertiary London Hospital. Arch Gynecol Obstet 2005;271:154–159

Eniola OA, Bewley S, Waterstone M, Hooper R, Wolfe CD. Obstetric Hysterectomy in a population of South East England. J Obstet Gynaecol 2006;26(2):104–9.

Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation: Obstet Gynecol Surv 2007;62(8):529–39.

Whiteman MK, Kuklina E, Hillis SD, Jamieson DJ, Meikle SF, Posner SF et al. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol 2006;08(6):1486–92

Kastner ES, Figueroa R, Garry D, Maulik D. Emergency Peripartum Hysterectomy: Experience at a Community Teaching Hospital. Obstet Gynecol 2002;99:971–5.

Drife J, Lewis G. "Why mothers die 2000-2002: Sixth report of the confidential enquiries into maternal deaths in the United-Kingdom." London, United Kingdom. Royal Col Obstet Gynaecol (2004).

Mousa HA, Walk in Shaw S. Major post partum hemorrhage. Curr Opin Obstet Gynecol 2001;13(6):595–603.

Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. Cesarean Delivery and Peripartum Hysterectomy. Obstet Gynecol 2008 Jan; 111(1): 97¬–105

Selo Ojeme Do, Bhattacharjee P, Izuwa–Njoku NF, Kadir RA. Emergency Peripartum Hysterectomy in a Tertiary London Hospital. Arch Gynecol Obstet 2005;271:154–9.

Published

2015-03-01

Most read articles by the same author(s)