Emergency Peripartum Hysterectomy: “Saving Mother - Sacrificing Womb” (A 3 Year Review)
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 3
Abstract
Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics , remains a life saving procedure in cases of severe obstetric hemorrhage. Objectives: To determine the epidemiological factors, incidence , risk factors, indications, outcome and complications of emergency peripartum hysterectomies performed in a tertiary care hospital in RAJASTHAN, INDIA during a 3 yrs period with total deliveries of 65,720 . Method: The medical records of 60 patients who underwent EPH between june 2014 to june 2017 were reviewed retrospectively. Maternal characteristics and details of present pregnancy and delivery, indication of hysterectomy , operative complications, postoperative conditions and maternal and fetal outcome were evaluated. Results: There were 60 EPH out of 65,720 deliveries with a rate of 0.91 / 1000 deliveries. 16 were performed with cesarean deliveries and 25 after vaginal deliveries for atonic and traumatic PPH and abnormal placentation, 19 performed for ante partum or intrapartum rupture uterus. Mean maternal age was 30 -35 year, more common in multigravidas. Most common indication was PPH followed by rupture uterus . There were 6 cases with bladder injury and one case with intestinal injury , 54 needed blood transfusion of more than 3 units and internal iliac artery ligation was done in 3 cases. We had 1 maternal death because of septic shock & disseminated intravascular coagulation. There were 20 IUFDs and neonatal mortality occurred in 10 cases. Conclusion: Although Increasing trends for caesarian section are increasing the incidence of rupture uterus and morbidly adherent placenta in next pregnancy leading to EPH. Still haemorrhage either antipartum , intrapartum or postparum remains the leading cause of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face.EPH therefore remains an important procedure for saving mothers.
Authors and Affiliations
Dr Priyanka, Dr Indra Bhati
Keywords
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- EP ID EP369223
- DOI 10.9790/0853-1703060103.
- Views 73
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