Abstract

Introduction: Peripartum hysterectomy is performed as a life saving measure for intractable post partum hemorrhage not responding to conservative measures. The incidence of peripartum hysterectomy varies worldwide. In the United States, increase incidence has been noted. In India, various review of peripartum hysterectomy has been reported. The aim of the study is to analyse women undergoing peripartum hysterectomy. It describes the cause and outcome of women undergoing hysterectomy.

Method: A retrospective analysis was carried out for women who underwent peripartum hysterectomy at Jawaharlal Nehru Institute of Medical Sciences from January 2015- September 2018. Data abstraction was done from case files of women who underwent childbirth and obstetric hysterectomy.

Results and Analysis: 20 cases underwent peripartum hysterectomy from January 2015 to September 2018. During this period, a total of 20,327 deliveries were noted. A peripartum hysterectomy rate of 0.1% was noted. Majority of the women ages ranged between 30-40 years (70%). Majority of the indications for peripartum hysterectomies were due to placental abnormalities (45%) and uterine atony (40%). 2 (10%) cases of extensive uterine rupture and 1(5%) case of bleeding diathesis following abruption placenta were noted. Most women had prolonged hospital stay between 7-14days (12 cases). Fever was the most common post operative complication noted. Bladder injury occurred in 3 cases and it was associated with cases that had previous caesarean delivery. Wound sepsis was noted in 40% (8) cases. Blood transfusion was given in all cases; however 4 cases required massive blood transfusion. Post surgery all patients were observed for 24 hours in Surgical ICU, however, 35% (7) had prolonged stay in ICU. 10% (2 cases) maternal mortality was recorded. 3 neonatal mortality and 9 NICU admission was noted.

Conclusion: Good obstetric practice is essential to not only reduce the threshold for caesarean section but subsequently for decreasing the rate of peripartum hysterectomy associated with abnormal placentation consequent to caesarean delivery.

Keywords: Peripartum hysterectomy, uterine atony, abnormal placentation, obstetric hysterectomy, post partum hemorrhage.