Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Peripartum hysterectomy is a major operation and is invariably performed in the presence of life threatening hemorrhage during or immediately after abdominal or vaginal deliveries. Material and Methods: A Medline search was conducted to review the recent relevant articles in English literature on emergency peripartum hysterectomy. The incidence, indications, risk factors and outcome of emergency peripartum hysterectomy were reviewed. Results: The incidence of emergency peripartum hysterectomy ranged from 0.24 to 8.7 per 1000 deliveries. Emergency peripartum hysterectomy was found to be more common following cesarean section than vaginal deliveries. The predominant indication for emergency peripartum hysterectomy was abnormal placentation (placenta previa/accreta) which was noted in 45 to 73.3%, uterine atony in 20.6 to 43% and uterine rupture in 11.4 to 45.5%. The risk factors included previous cesarean section, scarred uterus, multiparity, older age group. The maternal morbidity ranged from 26.5 to 31.5% and the mortality from 0 to 12.5% with a mean of 4.8%. The decision of performing total or subtotal hysterectomy was influenced by the patient's condition. Conclusion: Emergency peripartum hysterectomy is a most demanding obstetric surgery performed in very trying circumstances of life threatening hemorrhage. The indication for emergency peripartum hysterectomy in recent years has changed from traditional uterine atony to abnormal placentation. Antenatal anticipation of the risk factors, involvement of an experienced obstetrician at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in reducing morbidity and mortality.

Original languageEnglish
Pages (from-to)358-361
Number of pages4
JournalNorth American Journal of Medical Sciences
Volume3
Issue number8
DOIs
Publication statusPublished - Aug 2011

Keywords

  • Peripartum hysterectomy
  • Placenta previa
  • Postpartum hemorrhage
  • Uterine atony
  • Uterine rupture

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome'. Together they form a unique fingerprint.

  • Cite this