Original Research Article
Year: 2020 | Month: March | Volume: 7 | Issue: 3 | Pages: 206-210
Emergency Peripartum Hysterectomy- Burden, Risk Factors and Surgical Outcomes in a Tertiary Care Hospital
Anuvi1, Ratnesh2, Lavanya Kiran1
1Department of OBG, Narayana Health City, Bengaluru, Karnataka, India
2Department of Community Medicine, Dumka Medical College, Dumka, Jharkhand, India
Corresponding Author: Ratnesh
ABSTRACT
Introduction: Emergency peripartum hysterectomy (EPH) is a major operation and is inevitably performed in massive haemorrhage during or immediately after caesarean or vaginal deliveries. The objective of our study was to find the burden of EPH with associated risk factors and surgical outcomes
Methodology: A retrospective observational study was conducted in a tertiary care centre in Bengaluru, India from September 2016 to August 2019 which included 10 women who underwent EPH after 22 weeks of pregnancy and within 6 weeks of delivery. Socio demographic and clinical profile, intraoperative findings, additional procedures like uterine artery embolization (UAE) or administration of recombinant factor VIIa (rfVIIa),surgical outcomes and postoperative complications were noted.
Results: The burden of EPH was found to be 2.2/1000 deliveries. Major indication of EPH was morbidly adherent placenta (60%) which was associated with placenta previa in 40% cases. Mean maternal age and gestational age at which EPH was performed was 30±6.3 years and 33.7±4.2 weeks respectively. Subtotal and total hysterectomy were performed in 50% cases each. Main intra-operative complication was haemorrhage. Surgical relaparotomy was done in 30% cases. Additional procedure of UAE and administration of rfVIIa was done in 20% and 10% patients respectively. Mean duration of ICU stay was 3.50±3.8 days. Mortality was seen in 2 patients.
Conclusion: Morbidly adherent placenta was the major cause for EPH attributed to high rate of primary caesarean deliveries. Early diagnostic facility can help us to detect these beforehand and plan the procedure electively so that related morbidity and mortality is reduced.
Keywords: Emergency peripartum hysterectomy, Morbidly adherent placenta, Placenta previa, Postpartum haemorrhage.
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