EMERGENCY PERIPARTUM HYSTERECTOMY: INDICATIONS AND OBSTETRIC OUTCOME (A 5-YEAR REVIEW)

Objective: To review cases of emergency peripartum hysterectomy regarding their incidence, risk factors, indications and complications and their results were carefully analysed. Materials and method: A retrospective study of cases of emergency peripartum hysterectomy which were performed in the period between January 2011 and December 2015 at R. G. Kar Medical College & Hospital in West Bengal was done. Clinical data were extracted and closely interpreted. Results: In the study period there were 84,093 deliveries and 81 cases of peripartum hysterectomies. The overall incidence was 0.096%. Caesarean hysterectomy was performed in 51 cases (0.373%) and postpartum hysterectomy was performed in 30 cases (0.042%). Total hysterectomy was performed in 23cases (28.4%) and subtotal hysterectomy was performed in 58 cases (71.6%). The main indications for hysterectomy were uncontrolled postpartum haemorrhage (43.2%), ruptured uterus (32%) and morbidly adherent placenta (24.7%). There were 9 maternal deaths and 32 cases of stillbirths. Conclusion: Peripartum hysterectomy is a major, life saving operation. Although PPH is the main indication, it is significantly associated with post caesarean cases. Obstetricians should identify patients at risk and anticipate the procedure and complications, as early intervention and proper management facilitate optimal outcome.