European Journal of Molecular & Clinical Medicine

Abstract

Introduction: Emergency Peripartum Hysterectomy (EPH), although relatively infrequent in present day obstetrics, is a life-saving procedure in the event of a massive postpartum hemorrhage.
Aim: To assess incidence, risk factors, indications and complications of peripartum hysterectomies at a tertiary care teaching hospital in India.
Materials and Methods: A retrospective study was conducted at a tertiary care medical teaching hospital in Telangana. All emergency peripartum hysterectomies performed between May, 2017 and May 2022 at a tertiary care teaching hospital, were included in the study. Demographic characteristics, risk factors, antepartum, intrapartum and post-partum events, need for blood transfusion, length of stay in intensive care unit and postoperative complications were noted. Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 24. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD.
Results: Among 42703 deliveries conducted in the study period, 19306 were cesarean sections. 39 emergency peripartum hysterectomies were undertaken, the incidence being 0.09%. Women were aged 20 to 40 years (25 ± 2.83years). Majority (92.31%) were multiparous women. Placental & Atonic PPH (Placenta previa, Placenta accreta, adherent placenta) were the most common (66.60%) indication for hysterectomy. About 48.70% of hysterectomies performed were subtotal hysterectomies. More than half of them had a previous caesarean section. Two patients had bilateral internal iliac artery ligation for ongoing hemorrhage. All patients required intensive care and blood transfusion. Four patients did not survive even after hysterectomy.
Conclusion: Placental causes and Atonic PPH were the most common reason for performing an emergency peripartum hysterectomy. Women with previous caesarean section are at increased risk, both due to atonic and traumatic postpartum hemorrhage. Regular departmental audits are needed to formulate appropriate protocols to decrease mortality and near-miss events like EPH. Stringent protocols should be instituted for managing obstetric hemorrhage. Although EPH is lifesaving, early intervention by a senior obstetrician well versed with conservative procedures may avoid morbidity associated with EPH