Volume: 4 Issue: 1
Year: 2016, Page: 41-44,
Introduction: Emergency peripartum hysterectomy (EPH) is a major surgical procedure performed for life threatening obstetrical hemorrhage, during or immediately after abdominal and vaginal deliveries. It is considered as one of the most dramatic operations in modern obstetrics, performed after failure of all conservative methods to secure haemostasis in the presence of uncontrollable hemorrhage. In majority of the cases it is unavoidable, unplanned and needs to be performed expeditiously to minimize the complications. Peripartum hysterectomy being an unplanned emergency is associated with significant morbidity and mortality.
Aims and objectives :The objective of this study was to estimate the incidence, indications, risk factors and the maternal outcome, associated with emergency peripartum hysterectomy performed in a tertiary care center.
Material and Methods:A retrospective observational study of patients was conducted at the Department of Obstetrics and Gynaecology, at Prathima Institute of Medical Sciences, from July 2012 to June 2015. Records of all patients, who had undergone peripartum hysterectomy during the study period were obtained. Data was collected and analyzed to estimate various demographic characteristics, obstetric characteristics, indications & type of operation performed. Maternal and perinatal outcome were evaluated.
Results: During the 3 years of study period, 10 cases had undergone EPH. The estimated incidence was 1.9 per 1000 deliveries. Commonest indication of EPH in our study was abnormal placentation (placenta previa with or without morbidly adherent placenta). We performed total hysterectomy in eight cases (80%) and subtotal hysterectomy in 2 cases (20%). Blood transfusion was required in all women who underwent EPH, but more than five units was transfused in 5 cases. Bladder injuries were observed in 2 cases. Febrile illness observed in four cases of EPH. One case underwent relaparotomy for haemoperitoneum and one case was complicated with DIC. No maternal mortality was observed in this study
Conclusion: EPH is a life saving procedure for managing life threatening obstetrical hemorrhage, when all other conservative methods fail. Most of the time it is unplanned and unavoidable. Therefore antenatal anticipation of risk factors, involvement of experienced obstetrician and a prompt and timely intervention may improve the outcome.
Keywords: Peripartum Hysterectomy,emergency, hemorrhage,haemostasis
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Ipsita, Subha, Pruthwiraj, Sindhuja. Emergency peripartum hysterectomy: A three year experience at a tertiary care center. Perspectives in medical research 2016;4:1:41-44.