Emergency peripartum hysterectomy is one of the most dramatic operative procedures in modern obstetrics. The reported incidence is 0.24 to 8.9 per 1000 deliveries. Previously uterine atony was the most common indication for emergency hysterectomy but the recent studies have shown a shift towards abnormal placentation.
Objectives: To evaluate the clinical indications and incidence of emergency peripartum hysterectomy.
Methods: We retrospectively analyzed the number of women who underwent emergency peripartum hysterectomy in the hospital from January 2016-2018. Post-operative maternal and foetal complication were also evaluated. The surgical procedures, type of anesthesia, and the subsequent treatment, complications of hysterectomy, amount of blood transfused, need for ICU stay and total days of hospitalization were noted.
Results: Emergency peripartum hysterectomy was performed in 131 women. The incidence of emergency peripartum hysterectomy was 2.89/1000 deliveries. Emergency peripartum hysterectomy was performed in 78.62% cases (103 women) after cesarean delivery and 21.37% cases (28 women) after vaginal delivery. Subtotal hysterectomy was performed in 75.57% cases (99 women) and total hysterectomy was performed in 24.43% cases (32 women). The main indication for performing emergency peripartum hysterectomy was placenta praevia with accreta in 67 women (51.14%), uterine rupture in 31 women (29.66%), uterine atony not responsive to conservative treatment in 20 women (51.26%) and broad ligament hematoma in 13 women (9.92%).
Conclusion: The indications of peripartum hysterectomy have changed especially in the setting of rising caesarean rate all over the world. The possibility of the morbid adherence of placenta in presence of previous LSCS should always be kept in mind.