Publication:

Clinical study of emergency peripartum hysterectomy for postpartum hemorrhage

Background The objective of this study was to study indications and the outcome of emergency peripartum hysterectomy for PPH in a tertiary care centre and to study the maternal mortality and morbidity in these patients.

Methods This is an observational study conducted at Vanivilas hospital attached to Bangalore Medical College and Research Institute between January 2014 to December 2015 for 24 months. The women who fulfill the inclusion criteria are studied with respect to parity, gestational age at delivery, route of delivery (vaginal/cesarean), details of instrumental delivery, conservative methods used to control bleeding, ICU admissions and blood transfusions. An analysis of maternal mortality and morbidity was done with respect to development of hypovolemic shock, DIC, anemia, acute kidney injury, septicemia and maternal deaths.

Results The rate of peripartum hysterectomy is 10.1 per 1000 live births. Placental abnormalities (placenta previa and placenta accreta) are the leading indications (41.4%) for peripartum hysterectomy followed by uterine atony (34.5%). All 29 women received blood and blood product transfusions. 34.5% developed febrile morbidity, 27.6% developed DIC, 10.3% developed acute kidney injury and septicemia and 10.3% maternal deaths.

Conclusions PPH is unpredictable in onset, duration and etiology and it remains a major life threatening complication of any delivery. The most common causes of hemorrhage in these women are placental abnormalities and uterine atony. When conservative treatment is not feasible or has failed, prompt peripartum hysterectomy is performed failing which the delay would contribute to the maternal morbidity and mortality.