INCIDENCE, INDICATION AND OUTCOME OF EMERGENCY PERIPARTUM HYSTERECTOMIES IN A TERTIARY CARE HOSPITAL

Abstract

BACKGROUND: Emergency peripartum hysterectomy is the life-saving procedure to control a life-threatening haemorrhage performed at the moment or within 24 hrs of delivery (caesarean or vaginal). It is linked to a substantial percentage of maternal morbidity and mortality.AIM:To estimate the incidence,indication,and outcome of emergency peripartum hysterectomy over a 1-year period in a tertiary care hospital and the leading cause of the increased no of hysterectomies in the defined time interval. MATERIAL AND METHODS: This is a prospective study done in SMGS HOSPITAL, JAMMU, a tertiary care hospital. This study included all women who underwent emergency peripartum hysterectomy over a span of 1 year (August 1,2021,to July 31,2022).Detailed review including previous obstetric history, details of index pregnancy, an indication of peripartum hysterectomy, outcome, and infant morbidity was taken into account. RESULTS: During the course of the research, there were 33 women who had undergone peripartum hysterectomy. The incidence rate was 1.8 cases per 1000 births. The predominant indications were placenta accreta (69%),Atonic PPH (Postpartum haemorrhage) (18%),and uterine rupture (9%).Emergency peripartum hysterectomies were more prevalent after caesarean section (73%) than vaginal births (27%).Previous caesarean,multiparity,any past uterine surgeries, and older age were risk factors. 48% of women needed intensive care postoperatively.The common maternal complications were bladder injury (intraop) (12%), febrile morbidity (18%), disseminated intravascular coagulation (DIC) (8%),acute kidney injury (AKI) (9%),and wound infection (10%).There were 2 maternal deaths (6%) following emergency peripartum hysterectomy. The patient's condition was taken into consideration while deciding whether a complete or partial hysterectomy would be best.CONCLUSIONS: Abnormal placentation,placenta accreta, has surpassed uterine atony as the leading cause of emergency hysterectomy during the perinatal period in recent years. The primary reason for this is the growing popularity of caesarean sections. Peripartum hysterectomies for diagnosed cases of placenta accreta with antenatal anticipation of the risk factors,a multidisciplinary approach and ICU backup had better outcomes with less morbidity.An important factor influencing the maternal outcome was the timing of the decision to perform a peripartum hysterectomy which is neither too early nor too late