Emergency peripartum hysterectomy : experience at Basrah maternity and Children Hospital

Abstract EN

To estimate the incidence, indications, risk factors and complications associated with emergency peripartum hysterectomy, we analyzed retrospectively all cases of emergency peripartum hysterectomy performed at Basrah Maternity and Children from 1st of January 2005 to 31st of December 2007.

Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 hours after delivery.

There were 20 emergency peripartum hysterectomy among 51, 121 deliveries for a rate of 0.3/1000.

Fifteen women (75%) were delivered by caesarean delivery.

Eighteen women were multiparous and 2 were primiparous.

Most frequent indications were placenta accrete (60%), 9 with praevia and 3 with out praevia), followed by uterine atony in (20%), uterine rupture in (10%), extended cervical tear in (5%), and retroperitoneal haematoma in 5%. Placenta accreta was the most common indication in multiparous women (66.6%, 12 of 18) while uterine atony was the most common in primiparous. Eleven out of 12 (91.7%) women with placenta accrete had a previous caesarean delivery.

Three (25%) had a previous one caesarean section and 8 (66.6%) women had ≥2 previous caesarean section.

Fourteen (70%) of hysterectomies were subtotal.

Intraopeartive complications were (15%) and Postoperative febrile morbidity was (60%).We concluded that placenta accreta has become the most common indication for emergency peripartum hysterectomy.

The number of caesarean deliveries increased the risk of placenta accreta proportionally.