Critical Evaluation of Emergency Peripartum Hysterectomy Cases in a Tertiary Care Centre in Eastern India.

Corresponding Author:
Dr. Pallab Kumar Mistri,
Rishi Arabindapally, 110 KM,
Roychowdhury Road, P. O. South Jagaddal,
P. S. Sonarpur, Kolkata-700151,
West Bengal, India.
E-mail: pallab1012@gmail.com

ABSTRACT

BACKGROUND

Emergency Peripartum Hysterectomy (EPH) is one of the most dramatic operations in modern obstetrics, performed only when all conservative measures have failed to achieve homeostasis in the setting of massive postpartum haemorrhage (PPH). We wanted to determine the incidence, indications, and outcomes, of EPHs done at Medical College & Hospital, Kolkata between January 1, 2017 and December 31, 2017.

METHODS

A retrospective review of all cases of EPH over a 12-month period was done. EPH was defined as hysterectomy performed for PPH unresponsive to other treatments within 24 hours of delivery. Relevant information was extracted from the hospital records and operation notes.

RESULTS

The highest proportion of women who had EPH was in the age-group 25 - 30 years (51.1 %). Majority of the subjects was from rural areas (61 %). Most patients had no formal education (51.6 %). Nearly two-thirds (58.1 %) of the husbands had an undergraduate education and belonged to middle socio-economic strata (52 %). There were 31 EPHs performed among 13490 deliveries within the study period, giving a rate of 2.29 per 1000 deliveries. Maternal mortality was 13% (95% Confidence Interval [CI] 1.16–24.8) and perinatal mortality rate was 35.5% (18.6 – 52.3). The most common presentation was bleeding per vagina (80.6%) and severe pallor (52%). Main indications included placenta accreta (38.2%), placenta previa (32.3%), placenta percreta (12.9), uterine atony (3.2%), abruptio placentae (3.2%), broad ligament haematoma (3.2%), uterine rupture (3.2%) and uncontrolled PPH (3.2%).

CONCLUSIONS

The rate of EPH in our institution is high. Abnormal placentation was the most common indication for EPH, requiring a total hysterectomy in most cases. A previous CS was an important pre-operative risk factor for abnormal placentation and in particular for pathological adherence of the placenta. Post-operative shock was associated with poor outcome. EPH in our centre remains associated with a high incidence of morbidity and mortality as our center is an apex referral tertiary centre.

KEY WORDS

Peripartum Hysterectomy, Post-Partum Haemorrhage, Placenta Accreta