Abstract

Background: Emergency peripartum hysterectomy has remained a challenging surgical procedure in obstetrics. It remains a significant practice in modern obstetrics as it can save lives.

Objective: This study sought to determine the incidence and indications for peripartum hysterectomy, evaluate the maternal outcome and assess the associated factors in women.

Methodology: This was a retrospective review of emergency peripartum hysterectomies performed between January 2016 and December 2020. Data were obtained from operating theater and labour ward records. Information on maternal age, parity, gestational age, booking status, education, indication for surgery, cadre of surgeon, length of surgery, estimated blood loss and any blood transfusion, post-operative complication, and mortality, were extracted. Data were analyzed using SPSS version 20. Categorical measurements were given as numbers and percentages, and numerical measurements as mean and standard deviation. The Chi-square test or Fisher exact test and analysis of variance test were used for statistical analysis of non-continuous and continuous variables as appropriate and statistical significance was set at p < 0.05.

Results: During the five-year study period, there were 11,981 deliveries, of which 30 women had emergency peripartum hysterectomy, giving an Incidence of 2.5 per 1000 deliveries and a ratio of 1: 400 deliveries. Their mean age ± SD was 33.93 ± 4.16years, majority 23 (76.6%) had parity of 2 - 4, 22 (73.3%) had gestational at time of delivery of ≥ 37 weeks, and 17 (56.7%) were unbooked. Commonest indication for emergency peripartum hysterectomy was uterine rupture 15(50.0%), followed by placenta praevia 10 (33.3%). The indications were significantly associated with booking status (P = 0.017). Subtotal abdominal hysterectomy was the most performed procedure in 22 (73.3%) of the women. There was a significant association between parity and the need for blood transfusion (P = 0.047). There were 6 (20.0%) maternal deaths, giving a mortality ratio of 1:5 women. The perinatal mortality was 13 (43.3%) or rate of 433 per 1000 live births. The commonest postoperative complication was anaemia occurring in 16 (53.3%) of the women.

Conclusion: The incidence of emergency peripartum hysterectomy in our center was high and majority occurred in unbooked patients. The commonest indications were uterine rupture and placenta praevia. Formal antenatal care, anticipation and prompt resuscitation and surgery will reduce the incidence.

Keywords: Peripartum Hysterectomy; Obstetric Hysterectomy; Uterine Rupture; Placenta Praevia; Postpartum Haemorrhage

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