A TEN YEAR REVIEW OF EMERGENCY PERIPARTUM HYSTERECTOMY IN A TERTIARY CARE HOSPITAL
Abstract
Background: Emergency peripartum hysterectomy (EPH) is a life saving procedure considered incases of severe haemorrhage unresponsive to medical and conservative surgical procedures. The aim
of present study was to review the frequency, indications, maternal morbidity and mortality
associated with emergency peripartum hysterectomy in a tertiary care hospital in a developing
country. Methods: This was a cross sectional study in which data was retrospectively collected from
January 2000 to December 2010. Main outcome measures were maternal morbidity and mortality
associated with EPH. Results: The incidence of EPH was 10.52/1000 deliveries. The main causes of
EPH were rupture uterus 76 (34.86%), atonic uterus 65 (29.81%), placenta accreta 19 (8.71%),
placenta previa 17 (7.7%), and placental abruption 36 (16.5%). Mostly subtotal hysterectomy was
the preferred method done in 196 (89.9%) of cases, while total abdominal hysterectomy was done
only in 22 (10.09%) of cases. The over all complication rate was 81.2% which included both minor
and major complications like hypovolemic shock 180 (82.5%), febrile morbidity 108 (49.5%),
wound infection 40 (18.3%), bladder injury 6 (2.75%), and thrombophlebitis 22 (10.09%). The
maternal mortality in present review was (10.5%). Conclusion: Frequency of EPH was found to be
high in this study. Obstetricians must be skilled in it particularly in developing countries where the
main indication of hysterectomy is rupture uterus.
Keywords: Emergency peri-partum hysterectomy, maternal morbidity, maternal mortality
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