PERIPARTUM HYSTERECTOMY; FREQUENCY, RISK FACTORS AND MATERNAL OUTCOME

Abstract

OBJECTIVE: To observe the frequency, indications and maternal
outcome associated with peripartum obstetrical hysterectomy and
to explore the preventable factors contributing towards the adverse
outcome.
METHODOLOGY: This cross-sectional descriptive observational study
was conducted at Women and Children Teaching Hospital, Bannu and
included all the patients who underwent peripartum hysterectomy due
to obstetrical complication from 1st Jan 2009 to 30th June 2010. Clinical
and socio-demographic data was collected for analysis.
RESULTS: During the study period, 4583 deliveries were conducted
and peripartum hysterectomies were performed in 34 (0.74%) patients.
Uterine rupture was the commonest indication (62%) and there was
no specific preference found for any type of hysterectomy. Most of
the subjects were transfused more than three units of blood and 40%
developed either acute potentially fatal or long term debilitating complications while the case fatality rate (CFR) was 2.9%. Grandmultiparity (n=24, 70.59%), previous or current cesarean section (n=22, 64.71%) and injudicious use of uterotonics during labour (n=21, 61.76%) were the common risk factors associated with peripartum hysterectomies and their morbidities. Shock (n=20, 58.82%), disseminated intravascular coagulation (n=5, 14.70%) and urinary tract injury (n=5, 14.70%) were the commonest complications.
CONCLUSION: Peripartum hysterectomies, performed in <1% deliveries
in our set up, are commonly performed for uterine rupture, with
CFR of 2.9%. Grandmultiparity and previous or current cesarean section
are common risk factors and shock is the commonest complication of
peripartum hysterectomy. Regular training and clinical audit of birth
attendants to prevent prolonged obstructed labor or hyperstimulation
of uterus may reduce this complication.
KEY WORDS: Peripartum hysterectomy, Uterine rupture, Postpartum
haemorrhage, maternal morbidity, maternal mortality.