A 5-years cross-sectional study of Peripartum hysterectomy at a tertiary care hospital in South India

Abstract

Background: Peripartum hysterectomy (PH) is an emergency obstetric procedure performed most commonly for intractable postpartum haemorrhage. Objectives: Our aim was to study the patient demographics, incidence, indications of PH and compare emergency vs elective PH. Patients and methods: This was a retrospective analysis of all cases of PH performed over 5 years at our tertiary care hospital. The association of variables was based on Chi-square test and Fisher’s exact test. Mann-Whitney U- test was used to compare the distributions between groups. Results: A total of 53 peripartum hysterectomies were done in a period between January 2016- to December 2020. Incidence of PH was 1.71/1000 deliveries. PPH was the commonest indication of PH followed by placenta previa. 12 were planned elective PH. Haemorrhage and bladder injury were commonly encountered intra-op complications. ICU admissions were mainly for management of shock, disseminated intravascular coagulation and renal failure. There were 7 maternal deaths noted. Emergency PH were associated with overall higher mortality and morbidity than elective PH. Conclusion: Multidisciplinary approach involving an experienced obstetrician, anaesthetist, urologist & intensivist is needed for management of patients warranting PH. Haemorrhage continues to be leading indication for Emergency PH with higher risk of mortality. Antenatal anticipation of risk factors and early referral will help reduce maternal mortality. Background: Peripartum hysterectomy is an emergency obstetric procedure performed most commonly for intractable Postpartum haemorrhage. Objectives: Our aim was to study the patient demographics, incidence, indications of PH and compare emergency vs elective PH. Patients and methods: This was a retrospective analysis of all cases of PH performed over 5 years at our tertiary care hospital. The association of variables was based on Chi-square test and Fisher’s exact test. Mann-Whitney U- test was used to compare the distributions between groups. Results: A total of 53 peripartum hysterectomies were done in a period between January 2016- to December 2020. Incidence of PH was 1.71/1000 deliveries. PPH was the commonest indication of PH followed by placenta previa. 12 were planned elective PH. Haemorrhage and bladder injury were commonly encountered intra-op complications. ICU admissions were mainly for management of shock, disseminated intravascular coagulation and renal failure. There were 7 maternal deaths noted. Emergency PH were associated with overall higher mortality and morbidity than elective PH. Conclusion: Multidisciplinary approach involving an experienced obstetrician, anaesthetist, urologist & intensivist is needed for management of patients warranting PH. Haemorrhage continues to be leading indication for Emergency PH with higher risk of mortality. Antenatal anticipation of risk factors and early referral will help reduce maternal mortality.

Keywords

• placenta previa
• postpartum haemorrhage
• rupture uterus
• caesarean section