Emergency Peripartum Hysterectomy: Indications and Outcome in a Tertiary Care Setting
Journal Title: Journal of Clinical and Diagnostic Research - Year 2017, Vol 11, Issue 3
Abstract
Introduction: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving procedure, mostly reserved for conditions deemed to be serious and life threatening, and not amenable to conservative methods. In the present scenario, the advent of newer medical and conservative surgical methods for controlling obstetric haemorrhage has influenced the incidence, trend and the outcomes of the procedure. Aim: To evaluate the demographic profile, indications, operative details, maternal morbidity and mortality and neonatal outcomes of women undergoing EPH. Materials and Methods: A descriptive analysis of case records of women who underwent EPH between September 2006 to July 2014, at Guru Teg Bahadur Hospital Delhi, India was done. Data were collected from the medical records department. Results: A total of 194 cases (n) were identified among 1,00712 deliveries, an incidence of 1.92 per 1000 deliveries. Majority of the women were unbooked i.e., they did not receive any form of antenatal care and were gravida 3 and above. The indications were atonic PPH in 89 (45.87%), rupture of unscarred uterus in 36 (18.56%), morbidly adhered placenta in 30 (15.46%), scar rupture in 20 (10.31%) and gangrenous uterus 19 (9.79%). The mean blood loss was around 1.6±0.45 litres. Approximately 14% cases underwent stepwise devascularisation prior to hysterectomy and in only 2% women, B-Lynch suture was applied. Thirteen (6.7%) cases had bladder injury and 22 (11.34%) needed re-laparotomy for hysterectomy. Around 76 (39%) women were shifted for ICU care. Nineteen (9.79%) women developed Disseminated Intravascular Coagulation (DIC). The case fatality rate was 7.2% and perinatal mortality was 30%. Conclusion: Atonic PPH remains the leading cause of EPH in our analysis. Surprisingly rupture of unscarred uterus was more common compared to scar rupture. Creating awareness among women to seek health services in time with facilities for early referral, teaching younger obstetricians with conservative surgical procedures like stepwise devascularisation steps and compressive sutures should be of utmost priority.
Authors and Affiliations
Anshuja Singla, Rajlaxmi Mundhr, Latika Phogat, Sumita Mehta, Shalini Rajaram
Keywords
Related Articles
- EP ID EP335883
- DOI 10.7860/JCDR/2017/19665.9347
- Views 115
- Downloads 0
Morel-Lavallee Lesions-Review of Pathophysiology, Clinical Findings, Imaging Findings and Management
Morel-Lavallee lesion is a post-traumatic soft tissue degloving injury. This is commonly associated with sports injury caused by a shearing force resulting in separation of the hypodermis from the deeper fascia. Most com...
Foetal Magnetic Resonance Images of Two Cases of Aicardi Syndrome
Cerebral malformations are of fundamental importance in the clinical diagnosis of Aicardi Syndrome (AS). Some of these anomalies like callosal agenesis, cysts formation, posterior fossa anomalies and gross interhemispher...
Comparison of Efficacy and Safety of Cefpodoxime and AmoxicillinClavulanate Potassium in Paediatric Acute Otitis Media in Children below Two Years: A Prospective Longitudinal Study
Introduction: Acute Otitis Media (AOM) is one of the frequently diagnosed diseases in children below two years. Amoxicillinclavulanate potassium is the first line drug in treatment of Paediatric AOM (PAOM). Cefpodoxime h...
Effect of Pre-Analytic Variables on Prothrombin Time and Activated Partial Thromboplastin Time
Introduction: Inadvertent inappropriate coagulation tests results are reported frequently inspite of using automated instruments and quality assurance measures, mostly due to pre analytical errors associated with sample...
Recurrent Stroke in a Young Adult due to Antiphospholipid Antibody Syndrome-A Case Report
ABSTRACT Antiphospholipid Syndrome (APS) is an autoimmune disease characterised by arterial thrombosis, venous thromboembolic complications, mild to moderate thrombocytopenia and/or pregnancy morbidities in the presence...