TITLE:
Assessment of the Cases Undergone Peripartum Hysterectomy in a Tertiary Care Hospital in the Last Three Years
AUTHORS:
Afroz Sayma, Gulshan Ara
KEYWORDS:
Peripartum Hysterectomy, Caesarean Section, Placenta Accreta
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.11,
September
13,
2018
ABSTRACT: Background: Emergency peripartum hysterectomy (EPH), although rare in modern
obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & complications of
peripartum hysterecomty performed in a tertiary care hospital & compare the
results with other reports in the literature. Methods: Twenty nine
peripartum hysterectomy cases carried out between July 2015
and June 2018 in Enam Medical College & Hospital, Savar,
Dhaka were evaluated retrospectively. Maternal characteristics and
characteristics of the present pregnancy and delivery, hysterectomy
indications, operative complications, postoperative conditions, and maternal
and neonatal outcomes were evaluated. Results: Peripartum hysterectomy incidence was found as 7.26 per 1000 deliveries.
The most common indication for hysterectomy was placenta previa with morbidly
adherent placenta (17/29) followed by post-partum haemorrhage due to uterine atony (6/29)
and ruptured uterus (6/29). There were 6 cases of intraoperative bladder injury. We had
5 maternal deaths, 3 of them were due to irreversible shock & 2 due
to septicaemia. There were 5 cases of neonatal mortality mostly because of prematurity
& asphyxia. All of the placenta previa with placenta accreta cases had at
least one previous cesarean section. All 6
ruptured uterus cases had history of previous caesarean section. It was found
that blood transfusion was required in all cases. Conclusion: Obstetric hemorrhages
are life-threatening clinical conditions & peripartum
hysterectomy is a necessary life-saving procedure. Abnormal placentation is the
leading cause of emergency peripartum hysterectomy specially in cases with previous cesarean section
history.