EMERGENCY PERIPARTUM HYSTERECTOMY: FREQUENCY, INDICATIONS AND MATERNAL OUTCOME
AbstractBackground: Emergency Peripartum Hysterectomy (EPH), although rare in modern obstetrics,remains a life saving procedure in cases of severe haemorrhage. The aim of present study was to reviewthe frequency, indication, associated risk factors, maternal morbidity and mortality associated withemergency peripartum hysterectomy in a private sector teaching hospital. Methods: This was aretrospective review carried out from August 2003 to September 2008. Main outcome measures werefrequency, indications, associated risk factors and maternal morbidity and mortality associated withEmergency Peripartum Hysterectomy. Results: The frequency of emergency peripartum hysterectomyover a study period was 0.42%. Mean age and parity of patients was 30.9±5.0 years and 4.52±1.8respectively. The mean gestational age at the time of delivery was 36±3.4 weeks. Nine (42.9%) patientshad previous history of caesarean delivery. Main indication for EPH were rupture uterus 7 (33.3%),uterine atony 6 (28.6%), morbid adherence of placenta 5 (23.8%) and severe bleeding from placentalbed in 3 (14.3%) patients. All woman required blood transfusion, 11 (52%) require ICU admission,81% were anaemic, 3 (14.3%) developed DIC, 4 (19%) pulmonary oedema, febrile illness 6 (28.6%)and wound disruption was seen in 3 (14.3%). The maternal mortality occurred in 4 (19%) cases.Conclusion: Frequency of emergency peripartum hysterectomy is high in our set up. High parity,rupture uterus, increase number of caesarean deliveries and abnormal placentation was identified as riskfactors for EPH. High frequency of maternal morbidity and mortality was observed in the present study.Keywords: Emergency Peripartum Hysterectomy, maternal morbidity, maternal mortality
Plauche WC, Grunch FG, Bourgeouis MO. Hysterectomy at
the time of cesarean section: analysis of 108 case. Obstet
Chestnut DH, Eden, RD, Gall SA, Parker RT. Peripartum
Hysterectomy: A Review of cesarean & postpartum
hysterectomy. Obstet Gynecol 1985;65:365–70.
Clark SL, Yeh SY, Phelan JP, Bruce S, Paul RH. Emergency
Hysterectomy for Obstetric haemorrhage Obstet Gynaecol
Stanco LM, Schrimmer DB, Paul RH, Mishell DR.
Emergency Peripartum hysterectomy and associated risk
factors. Am J Obstet Gynecol 1993;168:879–83.
Zelop CM, Harlow BL, Ferigoletto FD, Safon LE, Saltzman
DH. Emergency Peripartum hysterectomy. Am J Obstet
Kastner ES, figueroa R, Garry D, Maulik D. Emergency
Peripartum hysterectomy: Experience at a community
teaching hospital. Obstet Gynecol 2002;99:971–5.
Bakshi S, Mayer BA, Indication for and outcomes of
emergency Peripartum hysterectomy. A five years review. J
Reprod Med 2000;45:733–7.
Francois K, Ortiz J, Harris C, Foley MR, Elliott JP. Is
peripartum hysterectomy more common in multiple
gestations? Obstet Gynecol 2005;105:1369–2.
Ozumba BC, Mbagwu SC. Emergency obstetrics
hysterectomy In Eastern Nigeria. Int Surg 1991;76:109–11.
Mahmood S, Ayaz A. Obstetrical hysterectomy. J Sur Pak
Noor S, Majid S, Ruby N. An audit of obstetrical
hysterectomy. J Coll Physicians Surg Pak 2001;11(10):642–5.
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.
DasKalakis G, Anastasakis E, Papantoniou N, Mesogitis S,
Theodora M, Antsaklis A. Emergency Obstetric
hysterectomy. Acta Obstet Gynecol Scand2007;86:223–7.
J Ayub Med Coll Abbottabad 2009;21(1)
Ahmad SN, Mir IH. Emergency Peripartum Hysterectomy:
Experience at Apex Hospital of Kashmir Valley. Internet J
Gynecol Obstet 2007;8(2). Available from
Barclay DL, Hawkins BL, Freuh DM. Elective Cesarean
Hysterectomy. A five years comparison with cesarean
section. Am J Obstet Gynecol 1976;124:900–93.
Lau WC, Fung HY, Rogers MS. Ten years experience of
caesarean and postpartum hysterectomy in a teaching hospital
in Hong Kong. Eur J Obstet Gynecol Reprod Biol
Bashir A, Ashraf R, Gul A, Tajamul A. Peripartum
hysterectomy. Ann King Edward Coll 2007;13(1):111–2.
Knight M, UKOSS. Peripartum Hysterectomy in the UK:
management and outcomes of the associated Hemorrhage.
Rabenda-Lacka K, Wilczynski J, Radoch Z, Breborowicz
GH. Obstetrical hysterectomy. Ginekol Pol 2003;74:1521–5.
Zorlu CG, Turan C, Işik AZ, Danişman N, Mungan T,
Gökmen O. Emergency hysterectomy in modern obstetric
practice. Changing clinical perspective in time. Acta obstet
Gynecol scand 1998;77:186–90.
Armstrong CA, Harding S, Dickinson JE. Clinical aspects
and conservative management of placenta accereta.
Obstetrician Gynecologist 2004;6:132–7.
Ghatak DP, Rupture of the uterus. A Review of 146 cases.
Trop J Obstet Gynaecol 1990;8:41–4.
Gonsoulin W, Kennedy RT, Guidry KH. Elective versus
emergency cesarean hysterectomy cases in a residency
program setting. A Review of 129 cases from 1984 to 1988.
Am J Obstet Gynecol 1991;65(1):91–4.
Baskett JF. Emergency obstetric hysterectomy. J Obstet
Smith J, Mouse HA. Peripartum hysterectomy for primary
postpartum haemorrhage: incidence and maternal morbidity.
J Obstet Gynaecol 2007;27:44–7.