Peripartum hysterectomy: lessons learnt over a decade in a tertiary care center

Neeraj Kulkarni; S.M. Deepti Pinto Rosario; Bijesh Yadav; Manisha Madhai Beck; Ruby Jose

Volume : VI, Issue : V, May - 2017

Peripartum hysterectomy: lessons learnt over a decade in a tertiary care center

Neeraj Kulkarni, S. M. Deepti Pinto Rosario, Bijesh Yadav, Manisha Madhai Beck, Ruby Jose

Abstract :

Introduction: Peripartum hysterectomy (PH) is generally performed at the time or within 24 hours of delivery. The aim of the study is to study the setting, risk factors, outcomes in women who had PH in a tertiary care hospital in India, and to assess the resource preparation needed to manage the maternal morbidity in these women. Material and Methods: All women who had peripartum hysterectomy (PH) in the Institution from January 1, 2004 to December 31, 2013 were identified and data abstracted. Demographics, obstetric, surgical details of women who had PH, and details of the estimated blood loss, the quantity of blood and products transfused and other outcomes including involvement of organ systems were collected. Results: 21 women out of 1, 03,420 deliveries in the Institution, underwent PH, giving an incidence of 0.04% (1 in 2000 deliveries). The number of PH�s performed, increased from 6, between 2004 and 2007, to 31 between 2008 and 2013, a 70% rise. Caesarian delivery (CD) resulting in PH was common with scar dehiscence/ rupture 5(13.9%). Two common indications for PH were atonic uterus 15 (41.7%) and adherent placenta 7(19.4%). An estimated blood loss of >4000ml occurred in one third of them, 12 (33.3%). All the women had hematologic complications, liver and renal complications occurred in 1/3rd.Blood and blood products were transfused in 31(86.1%) and 66 % respectively. Conclusion: CD rates should be strictly ought down. In women with previous CD and abnormal placentation, the risk of PH should be anticipated and adequately prepared for.