Emergency peripartum hysterectomy: a 3 year review at a tertiary care hospital in Vindhya region of India

Neha Khatik, Avani Pandey, Shabd Singh Yadav, Kalpana Yadav


Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetric, still performed as lifesaving surgical procedure to control haemorrhage that is unresponsive to conservative treatment. The objective of this study was to review the incidence, indications, and predisposing factors and associated complications of EPH.

Methods: The present study is a retrospective study included 37 women who underwent EPH over a period of 3 year. The records were collected from medical record department.

Results: 37 patients underwent EPH during this period making an incidence of 1.1 per 1000 deliveries. Most common indication of EPH in present study was morbidly adherent placenta (MAP) seen in 19 cases (51.4%). 36 patients (97.4%) patient underwent cesarean section at the time of their index pregnancy and 25 out of 37 (67.6%) patient had undergone prior cesarean delivery. 20 (54%) patients underwent total abdominal hysterectomy (TAH) and 17 (46%) patients underwent subtotal hysterectomy (STH). Mean operative time, estimated blood loss, injury to urinary tract, febrile illness and duration of hospital stay was higher in TAH group as compared to STH group but difference was not statistically significant except for estimated blood loss. Maternal mortality was seen in 20% of cases and neonatal mortality was seen in 56.8% of cases.

Conclusions: EPH although lifesaving but have devastating consequences. EPH should be performed with a multidisciplinary team approach. Measures should be taken to reduce caesarean section rate.


Emergency peripartum hysterectomy, Postpartum hemorrhage, Morbidly adherent placenta, Total abdominal hysterectomy, Sub-total hysterectomy

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UNICEF. Maternal health–UNICEF’s concerted action to increase access to quality maternal health services. 2019. Available at: Accessed on: 20 June 2020.

Park EH, Sachs BP. Postpartum haemorrhage and other problems of third stage. In High Risk Pregnancy— Management Options, James DK, Steer PJ, Weiner CP, Gonik B, eds. W.B. Saunders, Philadelphia, Pa, USA, 2nd edition. 1999;1231-46.

Clark SL, Yeh SY, Phelan JP, Bruce S, Paul RH. Emergency hysterectomy for obstetric hemorrhage. Obstet Gynecol. 1984;64:376-80.

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

Awan N, Bennett MJ, Walters WA. Emergency peripartum hysterectomy: a 10-year review at the Royal hospital for women, Sydney. Aust N Z J Obstet Gynaecol. 2011;51:210-5.

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

Say L, Souza JP, Pattinson RC. Maternal near miss –towards a standard tool for monitoring quality of maternalhealth care. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287-96.

Colmorn LB, Petersen KB, Jakobsson M, Lindqvist PG, Klungsoyr K, Källen K, et al. The nordic obstetric surveillance study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery. Acta Obstet Gynecol Scand. 2015;94(7):734-44.

Knight M, Kurinczuk JJ, Spark P, Brocklehurst P, Committee UKOSSS. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol. 2008;111(1):97-105.

Nwobodo E, Nnadi D. Emergency obstetric hysterectomy in a tertiary hospital in sokoto, Nigeria. Ann Med Health Sci Res. 2012;2(1):37-40.

Korejo R, Nasir A, Yasmin H, Bhutta S. Emergency obstetric hysterectomy. J Pak Med Assoc. 2012;62(12):13221325.

Juneja SK, Tandon P, Mohan B, Kaushal S. A change in the management of intractable obstetrical hemorrhage over 15 years in a tertiary care center. Int J Appl Basic Med Res. 2014;4(1):17-9.

Royal College of Obstetrics and Gynaecology, Postpartum Haemorrhage, Prevention and Management (Guideline 52), RCOG. 2009. Available at: Accessed on: 20 July 2020.

Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstetr Gynecol Reprod Biol. 1993;48(1):15-8.

Zelop CM, Harlow BL, Frigoletto FD, Safon LE, Saltzman DH. Emergency peripartum hysterectomy. Am J Obstet Gynecol. 1993;168:1443-8.

Korejo R, Jafarey SN. Obstetrics hysterectomy - five years’ experience at Jinnah Postgraduate Medical Centre, Karachi. J Pak Med Assoc. 1995;45:86-8.

Tahmina S, Daniel M, Gunasegaran P. Emergency peripartum hysterectomy: A 14- year experience at a tertiary care centre in india. J Clin Diagn Res.2017;11:8-11.

Chawla J, Arora CD, 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.

Sharma B, Sikka P, Jain V, Bagga R, Suri V. Peripartum hysterectomy in a tertiary care hospital: Epidemiology and outcomes Improving outcomes for peripartum hysterectomy: Still a long way to go! J Anaesthesio Clin pharmacol. 2017;33:324-8.

Agrawal S. Peripartum hysterectomy in a teaching hospital in India. Asian J Med Sci. 2014;4(1):59.

Stanco LM, Schrimmer DB, Paul RH, Mischell DR. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol. 1993;168:879-83.

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

Marwaha P, Kaur M, Gupta A. Peripartum hysterectomy- a five-year study. J Obstet Gynecol India. 2008;58(6):504-6.

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

Roopnarinesingh R, Fay L, Mckenna P. A 27 year review of obstetric hysterectomy. J Obstet Gynaecol. 2003;23:252-4.

Kastner ES, Figueroa R, Garry D, Maulik D. Emergency peripartum hysterectomy: experience at a community teaching hospital. Obstet Gynecol. 2002;99:971-5.

Smith J, Mousa HA. Peripartum hysterectomy for primary postpartum haemorrhage: incidence and maternal morbidity. J Obstet Gynaecol. 2007;27:44-7.

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

Ahmad S, Mir I. Emergency peripartum hysterectomy: experience at apex hospital of Kashmir valley. Internet J Gynecol Obstet. 2006;8(2):1-4.

Sharma R, Shaheen, Pathak J. Peripartum hysterectomy review of 70 cases. South Asian Federation Obstet Gynecol. 2009;1(2):19-21.

Varalakshmi K, Rastogi R, Choudhary N. Study of maternal outcome in emergency peripartum hysterectomy at a tertiary hospital. Int J Reprod Contracept Obstet Gynecol. 2017;6:5602-8.

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

Abasiattai AM, Umoiyoho AJ, Utuk NM, Inyang-Etoh EC, Asuquo OP. Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria. Pan Afr Med J. 2013;15:60.

Korejo R, Nasir A, Yasmin H, Bhutta S. Emergency obstetric hysterectomy. JPMA. 2012;62:1322.

Sahu L, Chakravertty B, Panda S. Hysterectomy for Obstetric Emergencies. J Obstet Gynaecol India. 2004;54(1):34-6.