DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20193078

Challenges in emergency peripartum hysterectomy in initial phase of obstetrics practice: series of 9 cases

Ranima Deka

Abstract


Emergency peripartum hysterectomy (EPH) is usually done to control bleeding of life threatening peripartum haemorrhage when all of all conservative measures fail. It is a technically demanding surgical procedure that carries high rate morbidity and mortality. From January 2016 to January 2019 data of all EPH done by our in different hospital of the city is collected. Total of 9 patients fulfil the definition of EPH. We tried with all sorts as bimanual uterine compression, administration of oxytocin or prostaglandins, uterine packing, compression sutures such as the B-Lynch brace suture before operation to controlled haemorrhage. On failure of the above mentioned measure we plan EPH. We took help of a surgeon in all of 9 cases. Bleeding is the greatest challenge in our series. Out of 9 patient 8 patient survived, one patient died of bleeding due to DIC. There is one urinary bladder injury and repaired intraoperatively. All patient has minor wound infection and that was managed with oral antibiotics and wound dressings. Postoperative average ICU stay was 3 days. Average PRBC transfusion is 4 units and two patient required FFP transfusion. In one patient we did subtotal hysterectomy and in rest all other patient we did total hysterectomy. With good team work EPH can be done with acceptable morbidity and mortality.

 


Keywords


Coagulopathy, Peripartum hysterectomy, Peripartum haemorrhage, Transfusion, Uterine rupture, Uterine atony

Full Text:

PDF

References


Flory N, Bissonette F, Birik YM. Psychosocial effects of hysterectomy: literature review J Psychosom Res. 2005;59(3):117-29.

F Tallab, M Helewa, Peripartum Hysterectomy: 10-Year Experience in Two Manitoba Tertiary Centers. Ann Saudi Med. 1998;18(5):398-400

Doumouchtsis SK, Arulkumaran S. The morbidly adherent placenta: an overview of management options. Acta Obstet Gynecol Scand. 2010;89(9):1126-33.

Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH. Ten years of confidential inquiries into maternal deaths in France, 1998–2007. Obstet Gynecol 2013;122(4):752-60.

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

Liera H, von Heymannb C, Kortec W, Schlembach D. Peripartum Haemorrhage: Haemostatic Aspects of the New German PPH Guideline. Transfus Med Hemother. 2018;45(2):127-35.

Zhang Y, Yan J, Han Q, Yang T, Cai L, Fu Y, et al. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage A 12-year review. Medicine (Baltimore). 201796:(45):e8443.

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

Kwee A, Boto ML, Visser GH, Bruinse HW. Emergency peripartum hysterectomy: a prospective study in The Netherlands. Eur J Obstet Gynecol Reprod Biol. 2006;124(2):187-92.

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(2):139-41.

Uysal D, Cokmez H, Aydin C, Tolga CSS, Guzin K, Eroglu M, et al. Emergency peripartum hysterectomy: our 12-year experience. Arch Gynecol Obstet. 2014;289:953-8.

Bateman BT, Mhyre JM, Callaghan WM, Kuklina EV. Peripartumhy sterectomy in the United States: nationwide 14 year experience. Am J Obstet Gynecol. 2012;206(1):63.e1-8.

Rajan PV, Wing DA. Postpartum hemorrhage: evidence- based medical interventions for prevention and treatment. Clin Obstet Gynecol 2010;53(1):165-81.