K. Chandramathy1, Mini C. H2, Reshma L3, Anjana Warrier4
Emergency Peripartum Hysterectomy (EPH) implies removal of uterus at the time of delivery or in the immediate postpartum period, usually carried out as a last resort in uncontrollable life-threatening obstetric haemorrhage. Recent studies show an increase in these procedures being done for abnormal placentation, which refers to both placenta praevia and morbidly adherent placenta praevia or accreta.
The aim of the study is to determine the incidence, indications, risk factors and complications of Emergency Peripartum Hysterectomy (EPH).
MATERIALS AND METHODS
This is a retrospective case series involving detailed examination of the case records of patients for 3 years who had emergency peripartum hysterectomy between January 2013 and December 2015 in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode. We analysed the incidence, indications, risk factors, type of hysterectomy and the complications of emergency peripartum hysterectomy.
There were 49,125 deliveries of which 65.22% were vaginal and 34.78% were by caesarean section. Hundred and five women underwent emergency peripartum hysterectomy giving an incidence of 2.1 per 1000 deliveries. The indications of EPH were mainly placenta previa with prior caesarean section. Morbidly adherent placenta was seen in 60 of the 63 (60%) cases followed by atonic PPH (19%) and rupture uterus (10.47%). There were two cases of maternal death. Inadvertent cystotomy was the most important complication in our series (6.66%). Sixty nine (65.7%) had previous delivery by caesarean section and 74 (70.4%) women delivered by caesarean section.
Morbidly adherent placenta in women with prior CS was the most common indication to perform emergency peripartum hysterectomy. Timely decision for hysterectomy significantly reduced the maternal morbidity and is a lifesaving procedure.