Journal of AdvancedMedical and Dental Sciences Research

Aim: The aim of the study was to evaluate the incidence, predisposing factors & associated complications and outcome of emergency peripartum hysterectomy. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology. Age, parity, traumatic or atonic PPH, risk factors, complications were all studied in detail and analysed. Results: 50 underwent emergency peripartum hysterectomy, yielding to an incidence of 0.12%. 14 (28%) patients underwent emergency peripartum hysterectomy following vaginal delivery, among whom 3 (6%)patients had instrumental delivery and 33(66%) following caesarean section. The most common indications out of the incidence was atonic PPH, noted in 24 patients (48%), following vaginal delivery were 9 (18%), following caesarean section were 15 (30%). Indication for rupture uterus were 24 (48%), 12 (24%) following rupture of an unscarred uterus. 12 (24%) following rupture of scarred uterus. Due to secondary post- partum haemorrhage were 6(12%). Acute inversion of uterus was 1(2%). Out of 50 patients, 16(32%) patients experienced intra-operative hypotension, 8(16%) developed febrile illness, 31(62%) required ICU care. The mean hospital stay of the patients <10days were 18 (36%), >10days were 26(52%) patients. None of the 50 patients required re-laparotomy, 19(38%) patients went into DIC, 5(10%) experienced bladder injury due to involvement of bladder along the rupture of uterus ,repair done simultaneously during hysterectomy, 3(6%) patient developed vesicovaginal fistula post-operatively. 6(12%) patients who underwent emergency peripartum hysterectomy died during post-operative period. Maternal mortality was 12% in the study. Conclusions: Hysterectomy is a lifesaving procedure to control postpartum hemorrhage, but is associated with significant maternal morbidity and mortality. Uterine atony, uterine ruptures, also due to prior caesarean delivery, placenta previa were identified as risk factors.