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 91
- Downloads 0
Effect of Ethyl Acetate Extract of Melothria Perpusilla on Oral Glucose Tolerance Test in Albino Rats
Introduction: Diabetes mellitus is a group of common metabolic disorders sharing the phenotype of hyperglycaemia. Certain disadvantages like side effects or less efficacy limit the optimal use of antidiabetic drugs. Aim:...
Syphilis Screening in Pre-procedural Patients at a Tertiary Cardiac Care Centre in India
ABSTRACT Introduction: Routine pre-procedural screening for blood-borne infections is a common practice despite lack of standard guidelines. The incidence of syphilis has shown an upward trend in recent years. Aim: To de...
Atraumatic Acute Compartment Syndrome of Forearm Following Artificial Mehndi (Henna) Dermatitis – A Rare Case Report
Atraumatic compartment syndrome of the forearm is a rare entity. There are several papers available in the literature on the adverse effects of mehndi application; however Acute Compartment Syndrome (ACS) following mehnd...
Enzymatic and NonEnzymatic Virulence Activities of Dermatophytes on Solid Media
Introduction: Dermatophytes are keratinophilic fungi causing superficial cutaneous infections that account 20-25% of the global population. As per literature search, there is a dearth in the study on virulence factors of...
Cone-Beam Computed Tomography Evaluation of Vertical Bone Thickness of Midpalatal Suture Area in Young Patients: A Pilot Study
ABSTRACT Introduction: Miniscrews are devices used when absolute anchorage is required. They are easy to install and recommended for all ages. Aim: The aim of this study was to assess bone thickness of midpalatal suture...