Emergency peripartum hysterectomy: A five year study from a tertiary care hospital in Mysore, South India

Abstract

Introduction: Peripartum hysterectomy is defined as a hysterectomy performed at the time, or within 24 hours, of delivery. It is certainly a lifesaving procedure when all medical and surgical methods fail to control bleeding. Objective: To determine the incidence, indications, maternal and perinatal outcome of emergency peripartum hysterectomy (EPH). Methods: A retrospective, analytical study of all patients who underwent peripartum hysterectomy over a period of 5 years from January 2014 to September 2018 in the Department of Obstetrics and Gynecology, JSS Hospital an associated hospital of JSS Medical College, Mysuru. Results: There were 12 cases of peripartum hysterectomy (9 caesarean hysterectomies 75%, 3 postpartum hysterectomy 25%, making an incidence of 0.498/1000 deliveries. Most of the patients were para 8 (66.6%) were mostly in age group of 20-30 years and 10 (83.3%) belonged to rural areas. Overall the most common indication for emergency peripartum hysterectomy was uterine atony 9 (75%), abnormal placentation 3 (25%), uterine rupture 1(8.3%). One patient required total abdominal hysterectomy, 11 (91.6%) patients required subtotal hysterectomy. There were 2 (16.6%) maternal and 1 (8.3%) perinatal deaths; all were due to severity of conditions necessitating hysterectomy. Discussion: Atonic uterus was the commonest indication for emergency peripartum hysterectomy. Previous scar, multiparity and abnormal placentation were the significant risk factors. Conclusions: Emergency peripartum hysterectomy is potentially a lifesaving procedure, at times when all conservative surgical modalities fail and interventional radiology is not immediately available. It is associated with significant maternal morbidity and mortality.