Incidence and indications of peripartum hysterectomy among patients admitted in Dhaka medical college hospital

Rumana Afroz; Farhana Dewan; Manjuman Ara Sarker; Rifat Ara

doi:10.18203/2320-1770.ijrcog20242787

Authors

Rumana Afroz Department of Gynaecology and Obstetrics, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
Farhana Dewan Department of Gynaecology and Obstetrics, Ibn Sina Medical College and Hospital, Dhaka, Bangladesh
Manjuman Ara Sarker Department of Gynaecology and Obstetrics, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
Rifat Ara Department of Gynaecology and Obstetrics, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242787

Keywords:

Peripartum hysterectomy, Hysterectomy, Ruptured uterus, Uterine atony

Abstract

Background: Peripartum hysterectomy is a mutilating surgery in obstetrics. Peripartum hysterectomy remains one of the important procedures to reduce maternal mortality and morbidity in Bangladsh. The study aimed to determine the incidences of peripartum hysterectomy in patients admitted to Dhaka medical college hospital (DMCH) by thorough evaluation of cases.

Methods: This was a cross-sectional clinical study carried out in the department of obstetrics and gynaecology, DMCH. The duration of the study was one year, from July 2008 to June 2009. About 42 patients with peripartum hysterectomy took part in it. All patients who underwent peripartum hysterectomy with no other chronic illness, matched with age criteria, and gave consent were among the inclusion criteria. Data were collected and analyzed with the software SPSS.

Results: Incidence of 6.25 per 1000 deliveries. Majority age group 29-34 years (38.09%). P/V bleeding with shock (23.81%), P/V bleeding without shock (35.71%), term pregnancy with labor pain (21.43%), and ruptured uterus (19.05%). The primary indication was uterine rupture (57.14%), followed by postpartum hemorrhage (26.19%) and sepsis (4.76%). Subtotal hysterectomy was performed in 88.09% of cases. Intraoperative complications included severe hemorrhage (23.81%) and urinary bladder injury (14.28%). Postoperative complications included febrile morbidity (42.85%), wound infection (23.81%), and paralytic ileus (28.57%). Maternal mortality was 16.67%, and perinatal outcomes included 61.9% stillbirths, 9.52% early perinatal deaths, 4.76% requiring ICU support, and 28.57% alive.

Conclusions: Through effective antenatal care, reduced primary cesarean section rate, identification of patients at risk, enhancement of blood transfusion facilities, together with improvement of surgical skills the morbidity associated with the operation and mortality rate can be reduced.

Metrics

Metrics Loading ...

References

Dutta DC. Safe motherhood obstetric care and the society, epidemiology of obstetrics. In. Text Book of Obstetrics 6th edition. Calcutta New Central Book Agency (P) Ltd. 2001;642-45.

Lau WC, Fung HY, Rogers MS. Ten years experience of caesarean section and postpartum hysterectomy in a teaching hospital in Hong Kong. Eur J Obstet Gynecol Reprod Biol. 1997;74(2):133-7.

Chen LH, Tan KH, Yeo GS. A ten year review of uterine rupture in modern obstetric practice. Ann Acad Med (Singapore). 1995;24(6):830-5.

Edward H, Park Benjamin P. Sachs Postpartum Haemrrhage and other problems of third stage. In. High Risk Pregnancy, Management options 2nd ed. Philadelphia: W B Saunders, 1999;1231-46.

Osefo NJ. Caesarean and postpartum hysterectomy. Int J Gynecol Obstet. 1989;30:93-7.

Stanco LM, Schrimer BD, Paul RH, Mishel DR. Peripartum Hysterectomy. Am J Obstet Gynecol. 1993;168(3pt1):879-83.

Johanson R. Obstetric procedure. In. Edmonds D K. editor. Dewhurst’s Textbook of Obstetrics and Gynaecology for Postgraduates. 6th ed. London: Blackwell Science Ltd. 1999;325.

Zorlu CG, Turan C, Isik AZ, Danisman N, Mungan T, Gokmen O. Emergency Hysterectomy in modern obstetric practice Changing clinical perspective in time. Acta Obstet Gynecol Scand. 1998;77(2):186-90.

Miller DA, Diaz F, Paul RH. Vaginal Birth after caesarean: A 10 year experience. Obstet Gynecol. 1994;84(2):225-58.

Farmer RM, Kirschbaum T, Potter D. Uterine rupture during trail of labour after previous caesarean section. Am J Obstet Gynecol. 1991;165(4pt1):996-1001.

Suner S, Tagminash Piepert JF. Fatal spontaneous rupture of a gravid uterus. case report and literature review of uterine rupture. J Emerg Med. 1996;14(2):181-5.

Kastner ES, Figueroa R, Garry D, Maulik D. Emergency peripartum hysterectomy: Experience at a community hospital. Am J Obstet Gynaecol. 1998;153(6):857-63.

Bowman EA, Barelay DS, White LC. Caesarean hysterectomy: an analysis of 1000 consecutive operations. Bull Tulane Med Faculty. 1964;23:75.

Ogunniyi SO, Esen UI. Obstetric hysterectomy in Ile-Ife, Nigeria. Int J Gnaecol Obstet. 1990;32(1):23-7.

Prevedourakis CN. Emergency caesarean section. Int Surg. 1974;59(1):33-4.

Sturdee DW, Rushton DI. Caesarean and postpartum hysterectomy. 1968-1983. Br J Obstet Gynaecol 1986;93(3):270-4.

Rouf S, Nasrin N, Begum J, Begum MR, Nahar S, Begum A. Emergency peripartum hysterectomy-in a developing country. J Bangladesh Coil Phys Surg. 2002;20(2):68-75.

Afat RA, Alsayali Baloul SMA. Emergency Obstetric hysterectomy: 8 year Review at Taif Maternity Hospital, Saudi Arabia. Int J Gynaecol Obstet. 2000;50(5-6):28-32.

Tahir S, Aleem M, Akram S. Indication and maternal outcome of emergency peripartum hysterectomy. J Emerg Med. 2003;12:81-6.

Clark SL, Koonings PP, Phelan JP. Placenta praevia/ accreta and prior caesarean section. Obstet Gynaecol. 1985;66:84-92.

Potter D, Strong TH, Farmer RM, Kirschbaum T, Medians AL. Uterine rupture during trial of labour after previous caesarean section. Am J Obstet Gynaecol. l99l;165(4pt1):996-1001.

Phelan JP, Clark SL, Diaz F. Paul RH. Vaginal birth after caesarean. Am J Obstet Gynaecol. 1987;157(6):1510-5.

Paul RH, Phelan JP, Yeh SY. Trial of labour in the patient with a prior caesarean birth. Am J Obstet Gynaecol. 1985;151(3):297-304.

Giwa-Osagie F, Uguru V, Akinla O. Mortality and morbidity of emergency obstetric hysterectomy. Obstet Gynaecol. 1983;4:94-6.

Thonet RGN. Obstetric hysterectomy: an 11 year experience. Br J Obstet Gynaecol. 1986;93(8):794-8.

Rouf S, Siddiqua SF, Miah AH. The rising trend for caesarean birth rate in a tertiary referral and teaching hospital. Bang J Obstet Gynaecol. 2000;15(1):15.