DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160879

Clinical study of emergency peripartum hysterectomy for postpartum hemorrhage

Amudha S., Sarojini .

Abstract


Background: The objective of this study was to study indications and the outcome of emergency peripartum hysterectomy for PPH in a tertiary care centre and to study the maternal mortality and morbidity in these patients.

Methods: This is an observational study conducted at Vanivilas hospital attached to Bangalore Medical College and Research Institute between January 2014 to December 2015 for 24 months. The women who fulfill the inclusion criteria are studied with respect to parity, gestational age at delivery, route of delivery (vaginal/cesarean), details of instrumental delivery, conservative methods used to control bleeding, ICU admissions and blood transfusions. An analysis of maternal mortality and morbidity was done with respect to development of hypovolemic shock, DIC, anemia, acute kidney injury, septicemia and maternal deaths.

Results: The rate of peripartum hysterectomy is 10.1 per 1000 live births. Placental abnormalities (placenta previa and placenta accreta) are the leading indications (41.4%) for peripartum hysterectomy followed by uterine atony (34.5%). All 29 women received blood and blood product transfusions. 34.5% developed febrile morbidity, 27.6% developed DIC, 10.3% developed acute kidney injury and septicemia and 10.3% maternal deaths.

Conclusions: PPH is unpredictable in onset, duration and etiology and it remains a major life threatening complication of any delivery. The most common causes of hemorrhage in these women are placental abnormalities and uterine atony. When conservative treatment is not feasible or has failed, prompt peripartum hysterectomy is performed failing which the delay would contribute to the maternal morbidity and mortality.

Keywords


PPH, Uterine atony, Adherent placenta, Peripartum hysterectomy, Maternal morbidity, Maternal mortality

Full Text:

PDF

References


Carvalho JF, Cubal A, Torres S, Costa F. Emergency Peripartum Hysterectomy: A 10- ISRN Emergency Medicine, Volume 2012 (2012), Article ID 721918, 7 pages.

Kashani E, Azarhoush R. Peripartum hysterectomy for primary postpartum hemorrhage: 10 years evaluation; euro. J Exp Bio. 2012;2(1):32-6.

Kastner ES, Figueroa R. Emergency peripartum hysterectomy: experience at a community teaching hospital Obstet Gynecol. J. 2002;9(6):971-85.

Tarik Y, Zamzami Y. ication of emergency peripartum hysterectomy; in dArch Gynecol obstet. 2003;268:131-5.

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

Knight M. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage; BJOG: An International Journal of Obstetrics & Gynaecology. 2007;114(11):1380-7.

Obstetrical Hemorrhage. In: Cunningham FG, Leveno KJ, Bloom SL, Haulh JC, Gilstrap LC, Wenstrom KD, editors. Williams Textbook of Obstetrics, 24th ed. New York: McGraw-Hill, 2014. pp.780-789.

Omol Ohonsi A, Olayinka HT. Emergency peripartum hysterectomy in a developing country: J Obstet Gynecol Can. 2012;34(10):954-60.

Ustun ZY, Engin-Ustun Y, Sahin G. Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey. European Journal of Obstetrics Gynecology and Reproductive Biology. 2005;120(1):57-62.

Smith J, Mousa HA. Peripartum hysterectomy for primary postpartum hemorrhage. Pubmed –indexed for Medline. 2007

Clark SL, Yeh SY, Phelan JP, Bruce S. Emergency hysterectomy for obstetric haemorrhage: obstet gynecol. 1984;64:376-80.

Umezurike CC, Nkwocha G. treatment for primary postpartum hemorrhage; Niger J Med. 2007;16(3):219-33.