Introduction: Peripartum hysterectomy (PH) is a lifesaving procedure performed at the time of delivery or in the immediate postpartum period in case of intractable obstetrical hemorrhage unresponsive to other measures. The indication for such procedure is severe uterine hemorrhage that may be due to abnormal placentation, i.e., placenta accreta, uterine atony, uterine rupture, leiomyomas, coagulopathy, or laceration of a uterine vessel not manageable by mere conservative measures.
Materials and methods: This retrospective and analytical study was carried out at the Department of Obstetrics and Gynecology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar (SGRDIMSR, Amritsar), for a period of 2 years from January 2017 to December 2018. All the patients who underwent PH were reviewed. All concerned factors related to emergency and critical care were analyzed.
Results: Out of under study cases, nine PH were conducted, seven being emergency and two elective for placenta accreta. The incidence being 3.53%, main indications were placenta accrete, n = 4 (44.4%); atonic PPH, n = 3 (33.3%); rupture uterus, n = 2 (22.2%). Out of these, n = 8 (88.8%) were referred cases and n = 1 (22.2%) were elderly gravida, almost all patients went to intensive care unit (ICU), average ICU stay being 10 days. Massive blood transfusion was done in n = 3 (33.3%) patients. Morbidity encountered were sepsis, anemia, bladder injuries and hypertension which were analyzed in this study. There was one mortality of G5P3L3A1 in emergency with placenta covering os in shock with severe anemia where emergency hysterectomy was performed for placenta accreta.
Conclusion: Proper antenatal intrapartum care, early referral, and judicious decision making regarding cesarean section are the potential methods which can be implemented to prevent this catastrophic event. The anticipation of such complication by classifying those patients in the risk group, notifying a multidisciplinary team, and treatment, will greatly improve the final outcome.
Wise A, Clark V. Challenges of major obstetric hemorrhage. Best Pract Res Clin Obstet Gynaecol 2010;24:353–365. DOI: 10.1016/j.bpobgyn.2009.11.011.
Shellhas CS, Gilbert S, et al. Eunice kennedy shriver national institutes of health and human development maternal-fetal medicine units network. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol 2009;114(2): 224–229. DOI: 10.1097/AOG.0b013e3181ad9442.
Zwart JJ, Dijk PD, et al. Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands. Am J Obstet Gynecol 2010;202:150. DOI: 10.1016/j.ajog.2009.09.003.
Rachaga S, Sivanesaratnam V. Caesarean hysterectomy-a review of 21 cases in the University Hospital, Kuala Lumpur. Eur J Obstet Gynecol Reprod Biol 1984;16:321–326. DOI: 10.1016/0028-2243(84)90160-6.
Say L, Chou D, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2(6):e323–e333. DOI: 10.1016/S2214-109X(14)70227-X.
Wright JD, Devine P, et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol 2010;115:1187. DOI: 10.1097/AOG.0b013e3181df94fb.
Stankiewicz A, Pogany L, et al. Prevalence of self-reported hysterectomy among Canadian women, 2000/2001–2008. Chronic Dis Inj Can 2014;34(1):30–35.
Coulter A, McPherson K, et al. Do British women undergo too many or too few hysterectomies? Soc Sci Med 1988;27(9):987–994. DOI: 10.1016/0277-9536(88)90289-4.
Desai S, Campbell OM, et al. Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India. Health Policy Plan 2017;32(1):68–68. DOI: 10.1093/heapol/czw099.
Machqdo LSM. Emergency peripartum hysterectomy: incidence, indications, risks factors and outcome. N Am J Med Sci 2011;3:358–361. DOI: 10.4297/najms.2011.358.
Obiechina NJ, Eleje GU, et al. Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-years review. Nigar J Clin Pract 2012;15:168–171. DOI: 10.4103/1119-3077.97303.
Owolabi MS, Blake RE, et al. Incidence and determinants of peripartum hysterectomy in the metropolitan area of the District of Columbia. J Reprod Med 2013;58(3–4):167–172.
Bodelon C, Bernabe-Ortiz A, et al. Factors associated with peripartum hysterectomy. Obstet Gynecol 2009;114(1):115–123. DOI: 10.1097/AOG.0b013e3181a81cdd.
Nwobodo E, Nnadi D. Emergency obstetric hysterectomy in a tertiary hospital in sokoto, Nigeria. Ann Med Health Sci Res 2012;2(1):37–40. DOI: 10.4103/2141-9248.96935.
Pradhan M, Yong S. Emergency peripartum hysterectomy as postpartum hemorrhage treatment: incidence, risk factors, and complications. J Nepal Med Assoc 2014;52(193):668–676. DOI: 10.31729/jnma.2375.
Agrawal S, Yadav R, et al. Peripartum hysterectomy in a teaching hospital in India. Asian J Med Sci 2013;4(1):34–36. DOI: 10.3126/ajms.v4i1.6967.
Ehtisham S. Emergency peripartum hysterectomy. Pak J Surg 2011;27(4):288–291.
Kastner ES, Figueroa R, et al. Emergency peripartum hysterectomy: Experience at a community teaching hospital. J Obstet Gynecol 2002;99:971–975. DOI: 10.1097/00006250-200206000-00003.
Khanum F, Sadaf R, et al. Emergency peripartum hysterectomy in a Tertiary Care Hospital. J Med Sci 2013;21(2):58–61. DOI: 10.1007/s13224-013-0423-1.
Imudia AN, Awonuga AO, et al. Incidence, trends, risk factors, indications for and complication associated with cesarean hysterectomy: a 17 year experience from a single instution. Arc Obstet Gynecol 2009;280(4):619–623. DOI: 10.1007/s00404-009-0984-5.
Zelop CM, Harlow BL, et al. Emergency peripartum hysterectomy. Am J Obstet Gynecol 1993;168:1443–1448. DOI: 10.1016/S0002-9378(11)90779-0.
Chawla J, Arora C, et al. Emergency obstetric hysterectomy: a retrospective study from teaching Hospital in North India over Eight Years. Oman Med J 2015;30(3):181–186. DOI: 10.5001/omj. 2015.39.
Knight M, Kurinczuk JJ, et al. Cesarean deliveryand peripartum hysterectomy. J Obstet Gynecol 2008;111:97–105. DOI: 10.1097/01.AOG.0000296658.83240.6d.
Zahn CM, Yeomans ER. Postpartum hemorrhage: Placenta accretas, uterine inversion, and puerperal hematomas. Clin Obstet Gynecol 1990;33:422–431. DOI: 10.1097/00003081-199009000-00006.
Ananth CV, Smulian JC, et al. The association of placenta previa with history of cesarean delivery and abortion. A meta-analysis. Am J Obset Gynecol 1997;177:1071–1078. DOI: 10.1016/S0002-9378(97)70017-6.
Archana K, Sahay PB. A clinical review of emergency obstetric hysterectomy. J Obstet Gynaecol India 2009;59:427–431.
Omole-Ohonsi A, Taiwo Olayinka H. Emergency peripartum hysterectomy in a developing country. J Obstet Gynaecol Can 2012;34(10):954–960. DOI: 10.1016/S1701-2163(16)35409-3.
Knight M. UKOSS. Peripartum Hysterectomy in the UK: management and outcomes of the associated hemorrhage. BJOG 2007;114(11): 1380–1387. DOI: 10.1111/j.1471-0528.2007.01507.x.
Singh R, Nagrath A. Emergency obstetric hysterectomy-a retrospective study of 54 cases over a period of 5 years. J Obstet Gyneco India 2005;55:428–430.
Nazam R, Bansal P, et al. Emergency obstetrics hysterectomy: a retrospective study at a Tertiary Care Hospital. J Clin Diagn Res 2010;4:2864–2868.
Kwee A, Boto ML, et al. Emergency peripartum hysterectomy. a prospective study in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2006;124:187–192. DOI: 10.1016/j.ejogrb.2005.06.012.
Zorlu CG, Turan C, et al. Emergency hysterectomy in modern obstetric practice: changing clinical perspective in time. Acta Obstet Gynecol Scand 1998;77:186–190.
Hamsho MA, Alsakka M. Emergency obstetric hysterectomy in Qatar–a 20-year review. Int J Fertil Women's Medicine 1999;44(4): 209–211.
Umezurike CC, Feyi-Waboso PA, et al. Peripartum hysterectomy in Aba southeastern Nigeria. Australian New Zealand. J Obstet Gynaecol 2008 Dec 1;48(6):580–582.