Hysterectomy for Uncontrolled Postpartum Bleeding: A Retrospective Review

Background Postpartum hemorrhage is a major complication associated with pregnancy and delivery and is a leading cause of maternal morbidity and mortality. Emergency postpartum hysterectomy (EPH) is a surgical procedure usually performed as a life-saving measure to control massive hemorrhage. It includes both cesarean hysterectomies that are performed after cesarean delivery and postpartum hysterectomy performed after vaginal delivery. Despite the low frequency of EPH, the rising cesarean delivery rate in recent years and the increasing population with a scarred uterus may indirectly increase the incidence of EPH and its complications. Objective The purpose of this analysis is to determine the factors leading to and outcomes after EPH for uncontrolled postpartum hemorrhage in our hospital, in an era of increased cesarean deliveries. Methods and results The study included cases of EPH performed at the time or within 48 hours of delivery, and described factors leading to uncontrolled postpartum hemorrhage, in women who delivered after 30 weeks of gestation. It was an retrospectiv analysis of 42 cases, in Mbreteresha Geraldine hospital, since 2008-2013. Demographic maternal characteristics, previous uterine surgery, conservative procedures to prevent emergency postpartum hysterectomy, type of hysterectomy (total or subtotal), factors leading to emergency postpartum hysterectomy, and maternal morbidity and mortality related to emergency postpartum hysterectomy were ed, presented as proportional rates (percentage). Results and comment Maternal demographic characteristics showed that mean maternal age was 29, 24 years old. Parity was reported in all 42 women, most of whom were multiparous (54 %). The type of hysterectomy was specified in 57, 9 % of cases of emergency postpartum hysterectomy (total hysterectomies 18, 2 %, subtotal hysterectomies, 81, 8 %). Additional surgery was required in 5, 3 % of cases. Of these cases, 63.0 % had undergone uterine surgery in their obstetric history (-1) and15, 8 % of these cases underwent gynecologic surgery other than cesarean delivery. The indication for EPH was listed abnormal placental adhesion (38 %), uterine atony (29 %), placenta previa (12 %), undefined bleeding (9 %), abruptio placenta (7 %), uterine rupture/dehiscence (2 %), myoma (1 %), hematoma (1 %), other (less than 1 %). In 90 % of women, an attempt to stop bleeding was performed before hysterectomy with either administration of uterotonics, or surgical techniques (curetting of the placental in all dhe cases with cesarian delivery and only in 4 cases with vaginaly delivery. Maternal morbidity rate was 52, 6 % fever (36 %), KID (12 %), infection (16 %), genitourinary (11 %), pulmonary (11 %), gastrointestinal (5 %), neurological (3 %), renal (1 %), cardiovascular (1 %).44, 7 % of women required blood transfusion. The maternal mortality rate was 2.6 %, only one 42 cases. Conclusions or recommandations Women at highest risk of emergency hysterectomy are those who are multiparous, had a cesarean delivery in either a previous or the present pregnancy, or had abnormal placentation.