DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160848

Emergency peripartum hysterectomy in a tertiary hospital in Upper Egypt: six years analysis

Ahmed M. Abbas, Ahmed Y. Abdelbadee, Mariam T. Amin, Reham M. Abdelrahman, Sara M. Tolba, Ahmed R. Abdelkarim, Ahmed Y. Shahin, Safwat A. Salman

Abstract


Background: Emergency peripartum hysterectomy (EPH) is often performed for life-threatening obstetric conditions especially when conservative treatment approach fails to stop postpartum hemorrhage. The aim of the study is to detect the incidence, indications, and complications of EPH over 6 years in Assiut Women Health Hospital in Upper Egypt.

Methods: A historical cohort study conducted between January 2009 and December 2014. Detailed review of all files of cases of EPH including maternal age, parity, gestational age, type of delivery, indications for EPH and outcome of the hysterectomy.

Results: The overall incidence of EPH was 1.30 per 1,000 deliveries. The main indications for hysterectomies were uterine atony 60 (48.78 %), abnormal placentation 27 (21.95 %) and rupture uterus 25 (20.32 %). There were 48 (39.02%) maternal deaths, while the perinatal mortality was 20.32% (25 cases). Using multivariate logistic regression analysis, we found that woman’s age ≥ 40 years and parity ≥ 5 were the most significant independent predictors for maternal mortality in cases of EPH (OR 5.49; 95% CI 2.16 - 13.96) and (OR 0.34; 95% CI 0.15 - 0.77) respectively.

Conclusions: The incidence of EPH in Upper Egypt is high. Uterine atony is the major indication for EPH in our hospital. Late referral and delayed decisions to perform hysterectomy contributes in the high mortality rate.

Keywords


Peripartum hysterectomy, Uterine atony, Maternal mortality, Postpartum hemorrhage

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References


Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009;9:55.

Forna F, Miles AM, Jamieson DJ. Emergency peripartum hysterectomy: a comparison of cesarean and postpartum hysterectomy. Am J Obstet Gynecol. 2004;190:1440-4.

Ali MK, Badee AY, Abbas AM, Shazly SA. A novel technique for modified B-Lynch suture for the control of atonic postpartum haemorrhage. Aust N Z J Obstet Gynaecol. 2013;53:94-7.

Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone FD. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol. 2009;200:632 e1-6.

Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol. 2009;114:115-23.

Zeteroglu S, Ustun Y, Engin-Ustun Y, Sahin G, Kamaci M. Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey. Eur J Obstet Gynecol Reprod Biol. 2005;120:57-62.

Kwee A, Bots ML, Visser GH, Bruinse HW. Emergency peripartum hysterectomy: a prospective study in the Netherlands. Eur J Obstet Gynecol Reprod Biol. 2006;124:187-92.

Sakse A, Weber T, Nickelsen C, Secher NJ. Peripartum hysterectomy in Denmark 1995-2004. Acta Obstet Gynecol. 2007;86:1472-75.

Chestnut DH, Eden RD, Gall SA, Parker RT. Peripartum hysterectomy: a review of cesarean and postpartum hysterectomy. Obstet Gynecol. 1985;65:365-70.

Stanco LM, Schrimmer DB, Paul RH, Mishell DR Jr. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol. 1993;168:879-83.

Daskalakis G, Anastasakis E, Papantoniou N, Mesogitis S, Theodora M, Antsaklis A. Emergency obstetric hysterectomy. Acta Obstet Gynecol Scand. 2007;86:223-7.

Kastner ES. Figueroa R, Garry D, Maulik D. Emergency peripartum hysterectomy: experience at a community teaching hospital. Obstet Gynecol. 2002;99:971-5.

Yucel O, Ozdemir I, Yucel N, Somunkiran A. Emergency peripartum hysterectomy: a 9-year review. Arch Gynecol Obstet. 2006;274:84-7.

Allam IS, Gomaa IA, Fathi HM, Sukkar GF. Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study. Arch Gynecol Obstet. 2014;290:891-6.

Mesbah Y, Ragab A, Fialla E, Barakat R, Badawy A, Ragab Ahmed. Emergency peripartum hysterectomy: the experience of a tertiary referral hospital. Middle East Fertility Soc J. 2013;18:89-93.

Shellhaas CS, Gilbert S, Landon MB, et al. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol. 2009;114:224-9.

Sing A, Hada M, Yangzom K, Anita GC. Emergency peripartum hysterectomy. N J Obstet Gynaecol. 2006;1:33-6.

Imudia AN, Hobson DT, Awonuga AO, Diamond MP, Bahado-Singh RO. Determinants and complications of emergent cesarean hysterectomy: supracervical vs total hysterectomy. Am J Obstet Gynecol. 2010;203:221.e1-5.

Engelson IB, Albrechsen S, Iversen OF. Peripartum hysterectomy: incidence and maternal morbidity. Acta Obstet Gynecol Scand. 2001;80:409-12.

Bai SW, Lee HJ, Cho JS, Park YW, Kim SK, Park KH. Peripartum hysterectomy and associated factors. J Reprod Med. 2003;48:148-52.

Korejo R, Jafarey SN. Obstetrics hysterectomy—five years’ experience at Jinnah Postgraduate Medical Centre, Karachi. J Pak Med Assoc. 1995;45:86-8.

Obiechina NJ, Eleje GU, Ezebialu IU, Okeke CA, Mbamara SU. Emergency peripartum hysterectomy in Nnewi, Nigeria: a 10-years review. Niger J Clin Pract. 2012;15:168-71.

Karayalcin R, Ozcan S, Ozyer S, Mollamahmutoglu L, Danisman N. Emergency peripartum hysterectomy. Arch Gynecol Obstet. 2011;283:723-7.

Imudia AN, Awonuga AO, Dbouk T, Kumar S, Cordoba MI, Diamond MP, et al. Incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy: a 17-year experience from a single institution. Arch Gynecol Obstet. 2009;280:619-23.

Whiteman MK, Kuklina E, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, et al. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol. 2006;108:1486-92.

Mahmood S, Ayaz A. Obstetrical hysterectomy. J Sur Pak. 2005;10:20-3.

Anita K, Kavita W. Emergency peripartum hysterectomy. J Obstet Gynaecol India. 2005;55:132-4.

Begum M, Alsafi F, ElFarra J, Tamim HM, Le T. Emergency peripartum hysterectomy in a tertiary care hospital in saudia Arabia. J Obstet Gynaecol India. 2014;64:321-7.

Awan N, Bennett MJ, Walters WA. Emergency peripartum hysterectomy: a 10-year review at the Royal hospital for women, Sydney. Aust N Z J Obstet Gynaecol. 2011;51:210-5.

Knight M, Ukoss M. Peripartum hysterectomy in the UK: management and outcomes of the associated hemorrhage. BJOG. 2007;114:1380-7.