Emergency peripartum hysterectomy in a teaching hospital in Eastern Taiwan

Emergency peripartum hysterectomy: A great obstetric challenge

Objective:

To determine the prevalence, etiology and complications of emergency obstetric hysterectomy (EOH) at a tertiary care hospital in Karachi.

Methods:

This was a retrospective cohort study which was carried out in the Department of Obstetrics & Gynecology Unit II, Civil Hospital Karachi from March 2015 to March 2017. All patients undergoing EOH were included in the study. Data was collected from medical files and labor room registers in accordance with ethical guidelines. Information included demographic characteristics, reasons for EOH, procedure associated morbidity and mortality. Data was recorded on a predesigned pro forma and analyzed using IBM SPSS Statistics for Macintosh, Version 18.0.

Results:

Out of 7,968 deliveries in two years, 32 patients under went EOH, (prevalence 4.01 per 1,000 deliveries). The mean age was 30.0 ± 5.2 years. Most women (75%) were multipara. The main mode of delivery was caesarean section (80%), mostly done as an emergency procedure (81%). In 10(30%) patients EOH was performed for uncontrollable hemorrhage due to uterine atony, followed by a morbidly adherent placenta (28%). Morbidity included disseminated intravascular coagulation (DIC) in four patients(19%) and three patients underwent repeat laparotomy for uncontrollable hemorrhage. There were three maternal deaths, giving a case-fatality index of 9.3%.

Conclusion:

Uterine atony and morbidly adherent placenta were the main reasons for emergency obstetric hysterectomy (EOH) in our set up.

Changing trends in emergency peripartum hysterectomy in a tertiary obstetric center in Turkey during 2000-2013

OBJECTIVE

To evaluate emergency peripartum hysterectomy (EPH) cases over a 14-year period in a tertiary center in İstanbul, Turkey.

MATERIAL AND METHODS

In this retrospective descriptive study, the records of all cases of EPH performed at the Zeynep Kamil Women and Children's Training and Research Hospital between January 2000 and January 2014 were analyzed. Results for 2000-2006 and 2007-2013 were compared to identify changing trends. Demographic and clinical factors associated with EPH were assessed.

RESULTS

During the 14-year study period, a total of 161,836 births occurred, out of which 104,783 (64.8%) were vaginal deliveries and 57,053 (35.2%) were cesarean section (CS). EPH was performed in 81 patients with an overall incidence of 0.5 in 1000 deliveries. The EPH rate in 2007-2013 (0.07%) was significantly higher than in 2000-2006 (0.03%). The major difference in the EPH populations between the two periods was the higher number of previous CS in 2007-2013 compared with 2000-2006 (p=0.01). Indications for EPH did not differ between the two periods. There were 7 (8.6%) maternal deaths in 2000-2013, with significantly fewer maternal deaths in 2007-2013 than in 2000-2006 (19.2% vs. 3.6%).

CONCLUSION

Rate of EPH increased considerably from 2000 to 2013. This increase was mostly related to the increasing rate of CS. Indications for EPH did not change over the study period, and the number of maternal deaths markedly decreased.