[Year:2019] [Month:January-June] [Volume:3] [Number:1] [Pages:5] [Pages No:8 - 12]
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.