Emergency peripartum hysterectomy and its association with cesarean section: a 3 years retrospective study


  • Harpreet Kaur Department of Obstetrics and Gynecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
  • Balpreet Kaur Department of Obstetrics and Gynecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
  • Sarvjeet Kaur Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India




Abnormal placentation, Cesarean section, EPH


Background: Emergency peripartum hysterectomy refers to the abdominal hysterectomy performed during or immediately after cesarean section or vaginal delivery, in a setting of life threatening haemorrhage. Over the past two decades, incidence of cesarean section has greatly increased which emerges as one of the cause for abnormal placentation in subsequent pregnancies thus resulting in increased incidence of haemorrhage. The unplanned nature of the surgery and acute blood loss renders the patient in a less than ideal situation to undergo such a dramatic surgery. Evaluation of risk factors, adequate resuscitation, involvement of senior obstetrician and timely decision for EPH in cases of refractory peripartum haemorrhage would help in significantly reducing the maternal mortality and morbidity. Objective was to study the association between cesarean section and emergency peripartum hysterectomy.  

Methods: It is a retrospective study of all women who had undergone emergency peripartum hysterectomy between January 2015 to January 2018 in the Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College, Faridkot. Incidence, indications, risk factors and complications of emergency peripartum hysterectomies (EPH) were recorded.

Results: During three years period the overall incidence of EPH was 1.85 per 1000 deliveries.

Conclusions: Emergency peripartum hysterectomy is a challenging procedure performed in obstetrics when all other conservative methods to control uterine haemorrhage have failed. With increased incidence of cesarean sections the cause of emergency peripartum hysterectomy has greatly shifted from uterine atony to abnormal placentation.  Abnormal placentation has now become the most commonly associated indication for EPH. Recognising and assessing patients at risk with appropriate and timely intervention would help in ensuring a better outcome in this otherwise difficult situation.


Clark SL, Yeh SY, Pheldon JP, etal. Emergency hysterectomy for obstetric hemorrhage. Obstet Gynecol. 1984;64:376-80.

Chestnut DH, Eden RD, Gall SA, Parker RT. Peripartum hysterectomy; a review of cesarean and postpartum hysterectomy. Obstet Gynecol. 1985;65:365-70.

Al‐Sibai MH, Rahman J, Rahman MS, Butalack F. Emergency hysterectomy in obstetrics- a review of 117 cases. Aust NZ Obstet Gynecol. 1987;27:180-4.

Christopoulos P, Hassiakos D, Tsitoura A, Panoulis K, Papadias K, Vitoratos N. Obstetric hysterectomy: a review of cases over 16 years. J Obstet Gynecol. 2011;31:139-41.

Kwee A, Boto ML, Visser GH, et al. Emergency peripartum hysterectomy. A prospective study in The Netherlands. Eur J Obstet Gynecol Reprod Biol. 2006; 124:187-92.

Machqdo LSM. Emergency peripartum hysterectomy: incidence, indications, risks factors and outcome. N Am J Med Sci. 2011;3:358-61.

Obiechina NJ, Eleje GU, Ezebialu IU. Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-years review. Nigar J Clin Pract. 2012;15:168-71.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-Placenta accreta. AM J Obstet Gynecol. 1997;177:210-4.

Karayalcin K, Ozcan S, Ozyser S, Mollamah mutoglu L, Danisman N. Emergency peripartum hysterectomy. Arch Gynecol Obstet. 2010;283(4): 723-27.

Yucel O, Ozdemir J, Yucel N, Somunkiran A. Emergency peripartum hysterectomy: a 9 year review. Arch Gynecol Obstet. 2006;274(2):84-7.

Zeteroglu S, Ustun Y, Engin-Ustun Y, Sahin G, Kamacı M. Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey. Eur J Obstet Gynecol Reproduct Biol. 2005 May 1;120(1):57-62.

Daskalakis G, Anastasakis E, Papantoniou N, Mesogitis S, Theodora M, Antsaklis A. Emergency obstetric hysterectomy. Acta Obstetricia et Gynecologica Scandinavica. 2007 Feb;86(2):223-7.

Baskett TF. Emergency obstetric hysterectomy. J Obstet Gynaecol. 2003 Jan;23(4):353-5.

Stanco LM, Schrimmer DB, Paul RH, Mishell Jr DR. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol. 1993 Mar 1;168(3):879-83.

Zorlu CG, Turan C, Işik A, Danişman N, Mungan T, Gökmen O. Emergency hysterectomy in modern obstetric practice changing clinical perspective in time. Acta Obstetricia et Gynecologica Scandinavica. 1998 Jan 1;77(2):186-90.

Hamsho MA, Alsakka M. Emergency obstetric hysterectomy in Qatar--a 20-year review. Int J fertil Women's Medicine. 1999;44(4):209-11.

Umezurike CC, Feyi‐Waboso PA, Adisa CA. Peripartum hysterectomy in Aba southeastern Nigeria. Australian New Zealand J Obstet Gynaecol. 2008 Dec 1;48(6):580-2.

Silipiopoulus M, Kareti A, Jain N, Kruce L, Hanlon A, Dandolu V. Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: date from a population based study. Arch Gynecol Obstet. 2011;283:1261-8.






Original Research Articles