Obstetric hysterectomy: an emergency lifesaving procedure

Authors

  • Meena N. Satia Department of Obstetrics and Gynaecology, Seth G. S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
  • Vibha More Department of Obstetrics and Gynaecology, Seth G. S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20162123

Keywords:

EPH, Caesarean, Multiparity

Abstract

Background: Although rare in modern obstetrics, emergency peripartum hysterectomy (EPH) remains a life-saving procedure, in the event of uncontrollable postpartum hemorrhage. Observations regarding the causes and outcomes of EPH provide valuable insights relevant to the current management perspectives in obstetrics. This study is intended to assess the contemporary prevalence, indications, and outcomes of EPH, at a Tertiary care referral institute.

Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 3 years January 2011-December 2013, in the department of obstetrics and gynecology, at the KEM hospital, in Mumbai. Cases of EPH were analyzed for information, maternal age, parity, gestational age, type of delivery, indications for EPH and outcomes of the procedure.

Results: The average annual incidence rate was1 per 1000 deliveries. 44% of the cases had an indication of abnormal placentation. 60% of the cases had caesarean section deliveries. Multiparity, previous LSCS, and gestation period of <37 weeks, were the commonly observed associations. 52% of cases required ICU admission. Maternal mortality rate was 8%. 20% of the cases had intrauterine fetal death.

Conclusions: Abnormal placentation was evident as the leading cause of uncontrollable hemorrhage. This is possibly in view of a continual improvement in the management of uterine atony, reduced incidence of uterine rupture, and importantly, a rising trend of caesarean section delivery. This calls for more thoughtful considerations, regarding decisions for caesarean section delivery, in obstetrics practice.

References

De la Cruz CZ, Thompson EL, O'Rourke K, Nembhard WN. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review. Arch Gynecol Obstet. 2015;292(6):1201-15.

Machado LSM. Emergency peripartum hysterectomy: incidence, indications, risk factors and outcome. N Am J Med Sci. 2011;3(8):358-61.

Nisar N, Sohoo NA. Emergency peripartum hysterectomy: frequency, indications and maternal outcome. J Ayub Med Coll Abbottabad. 2009;21(1):48-51.

Korejo R, Nasir A, Yasmin H, Bhutta S. Emergency obstetric hysterectomy. J Pak Med Assoc. 2012;62(12):1322-5.

Chawla J, Arora D, Paul M, Ajmani SN. Emergency obstetric hysterectomy: a retrospective study from a teaching hospital in North India over eight years. Oman Med J. 2015;30(3):181-6.

Mukherjee S, Agarwal L, Dahiya S, Amrin S, Singh P. A retrospective study of obstetric hysterectomy in a tertiary care hospital. Int J Med Sci Public Health. 2016;5(8):1-3.

Jayaram S, Varghese AP. A clinical review of obstetric hysterectomies done in medical college, Kottayam for a period of six years. Int J Reprod Contracept Obstet Gynecol. 2016;5(2):482-6.

Wani S, Fareed P, Gull Y, Mahajan N. Emergency peripartum hysterectomy: incidence, indications and fetomaternal outcome in a tertiary care hospital. IJCRR. 2016;8(3):7-10.

Kittur S, Swetha D. Emergency peripartum hysterectomy: a study in tertiary care centre and medical college in Hubli, North Karnataka, India. Int J Reprod Contracept Obstet Gynecol. 2016;5(4):1097-101.

Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012;207(1):14-29.

Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol. 2008;111:97-105.

Kwee A, Bots ML, Visser GH, Bruinse HW. Emergency peripartum hysterectomy: a prospective study in the Netherlands. Eur J Obstet Gynecol Reprod Biol. 2006;124:187-92.

Selo-Ojeme DO, Bhattacharjee P, Izuwa-Njoku NF, Kadir RA. Emergency peripartum hysterectomy in a tertiary Londonhospital. Arch Gynecol Obstet. 2005;271:154-9.

Stivanello E, Knight M, Dallolio L, Frammartino B, Rizzo N, Fantini MP. Peripartum hysterectomy and caesarean delivery: a population-based study. Acta Obstet Gynecol Scand. 2010;89:321-7.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226-32.

Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol. 2009;114:115-23.

Sheiner E, Levy A, Katz M, Mazor M. Identifying risk factors for peripartum cesarean hysterectomy. A population based study. J Reprod Med. 2003;48:622-6.

Whiteman MK, Kuklina E, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, et al. Incidence anddeterminants of peripartum hysterectomy. Obstet Gynecol. 2006;108:1486-92.

Stanco LM, Schrimmer DB, Paul RH, Mishell DR. Emergency peripartum hysterectomy and associated risk factors. American Journal of Obstetrics and Gynecology. 1993;168(3)879-83.

Baskett TF. Emergency obstetric hysterectomy. Journal of Obstetrics and Gynaecology. 2003;23(4):353-5.

Jakobsson M, Tapper AM, Colmorn LB, Lindqvist PG, Klungsøyr K, Krebs L, et al. Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS). Acta Obstet Gynecol Scand. 2015;94(7):745-54.

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Published

2017-02-23

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Original Research Articles