Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit. Future Emerging Problem in Obstetric Practice?
Author(s): Pathiraja P D M, Jayawardane A
Objectives: Peripartum hysterectomy is a dramatic obstetric surgery that is performed in emergency life saving situations or as an elective procedure in morbidly adherent placenta (MAP). Recently peripartum hysterectomy is performed more for MAP than obstetrics haemorrhage. The procedure is associated with significant morbidity and mortatlity. We report the demographic details of all patients who underwent peripartum hysterectomy over the period of one year in a tertiary care unit.
Methodology: A retrospective case note analysis were done from 1st June 2014 to 1st June 2015 at De Soysa Hospital for Women among all the mothers who had an emergency and elective peripartum hysterectomies.
Results: Eleven women had peripartum hysterectomies. Seven were due to MAP (63%). The rest were due to major post partum haemorrhage, which could not be managed medically, or with other surgical interventions. All women were multiparas and there were no maternal deaths during the study period. Nine patients had elective caesarean section (either lower segment or upper segment) and two delivered vaginally. Out of seven women with MAP five had planned peripartum hysterectomies and two were managed expectantly with methotrexate, which failed due to secondary haemorrhage. All patients had intensive care support after the surgery. All patients were managed in the multidisciplinary settings.
Conclusion: Evaluation of peripartum hysterectomy aids in the understanding of severe maternal morbidity which allowing for better resource utilization. Multidisciplinary team approach would results good maternal and fetal outcomes in peripartum hysterectomy cases.