EMERGENCY PERIPARTUM HYSTERECTOMY: INCIDENCE, INDICATIONS AND FETOMATERNAL OUTCOME IN A TERTIARY CARE HOSPITAL

2016-02-28T23-03-01Z
Source: International Journal of Current Research and Review
Saima Wani, Perveena Fareed, Yasmeena Gull, Neha Mahajan.
Objectives: The objectives of this study were to determine the incidence, maternal characteristics, indications and the maternal and perinatal outcome of emergency peripartum hysterectomies done in the Department of Obstetrics and Gynecology Government Medical College Srinagar. Study Design: This was a retrospective descriptive study done from January 2011-December 2013 over a three year period. Results: The incidence of peripartum hysterectomy during the study period was 1.46/1000 deliveries. The frequent age group was 31-35 years. The main indication of peripartum hysterectomy was life threatening hemorrhage due to uterine rupture (23), uterine atony (22), placenta accrete (18), placental abruption (16), placenta previa (13), broad ligament hematoma (7), retained placenta, Secondary postpartum hemorrhage and uterine fibroid (1 each) 81.37% hysterectomies were total and 16.63% were subtotal. The average pre- and intraoperative blood loss was 2.5 Lt +0.6. All patients needed blood transfusion. All patients received Perioperative antibiotics. Intraoperative complications developed in 15 patients which were bladder injury (5), Adnexial bleeding (5) and broad ligament hematoma (4). 69.6% patients needed intensive care. The common post operative complications were febrile morbidity (15.68%), wound sepsis (10.78%), pneumonia (8.82%), coagulopathy (5.88%), Cuff cellulitis and vesicovaginal fistula (1.96% each). The stillbirth rate was 303/1000. Most stillbirths occurred in uterine rupture (61.29%) followed by placental abruption (25.80%). Maternal mortality rate was 117/1000 live births. The average hospital stay was 13+4days. Conclusion: Emergency peripartum hysterectomy has significant effect on fetomaternal morbidity and mortality. Hence antenatal identification of high risk patients and proper management of second and third stage of labor and emergency preparedness are important in decreasing the rate of peripartum hysterectomy and improving the outcome.


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