Surgical Management of Postpartum Hemorrhage at Cocody University Hospital in the De Facto Capital City of Ivory Coast

Abstract

Background: Postpartum hemorrhage (PPH) is the most common cause of maternal mortality in low-and middle-incomes countries (LMICs). It is treated surgically when first line treatments fail. The goal of the sutdy is to report the results of surgical management of PPH at a University Hospital in the Capital of Côte d’Ivoire from 2015–2017. Methods: This was a retrospective study of all cases of PPH surgically managed at the university hospital of Cocody over two years. We did not include cases of maternal soft tissue injuries such as cervical, vaginal, vulvar and perineal lacerations. We studied the sociodemographic characteristics, surgical method performed and outcome of 54 cases who were operated on for PPH. Surgical management was either Radical Uterine Surgery (RUS): postpartum hysterectomy or Conservatice Uterine Surgery (CUS): hysterography, tsirulnikov triple ligation and bilateral hypogastric artery ligation (BHAL). No embolization was performed because it is not available in our country. Data were analyzed using Stata 13.1 software 2013, StataCorp, College Station-Texas, USA. Results: Of 23,730 deliveries there were 971 cases of PPH (4.1%) 54 of which (5.6% of PPH cases) were managed surgically. Of these, 34 were after cesarean and 20 after vaginal delivery. The mean age was 30 years and the mean parity was 3. Referred patients after PPH comprised 75.9% of cases. The average time elapsed from delivery to postpartum surgery was 133 minutes ± 33.39. The average time from admission to surgery was 86 minutes ± 53. Thirty-four underwent postpartum hysterectomy (63%) and 20 CUS (37%). N = 10 women (18.5%) died, 2 status post cesarean and 8 after vaginal delivery. All died within 120 minutes of postpartum surgery. Maternal morbidity was common such as postoperative anemia (68.2%), surgical site-infection (15.9%) and endometritis (6.8%). Conclusions: Postpartum hysterectomy was generally performed in older multiparous women and CUS in younger pauciparous women. None of the surgical options showed superiority over the others, however the small sample size does not allow generalization of the results. The choice of method should be guided by the condition of the mother, the experience and skill of the surgeon, the availability of the operating room, and the possibilities of resuscitation.

Keywords

• postpartum hemorrhage
• lmic
• hemostasis hysterectomy
• conservative uterine surgery
• post-operative outcome