Emergency Peripartum Hysterectomy: A Four year Cross sectional study in a tertiary care centre, Addis Ababa, Ethiopia

Abstract

<p><a rel="nofollow"></a><strong>Background</strong>: Emergency peripartum hysterectomy is a life-saving surgical procedure that is associated with maternal morbidity and mortality, especially in developing countries.</p> <p><a rel="nofollow"></a><strong>Objective: </strong>To evaluate the incidence, indications, postoperative maternal complications and maternal and neonatal mortality of emergency peripartum hysterectomy at St. Paul’s Millennium Medical College in Addis Ababa, Ethiopia.</p> <p><a rel="nofollow"></a><strong>Methods: </strong>We conducted a cross sectional study with review of medical records of all Emergency Peripartum Hysterectomy cases performed from January 2016 to December 2019 by using a pre-prepared, structured data extraction format; data entered with EpiDATA 3.1 and analyzed using StataCorp. 2015. Stata Statistical Software: release 14. Colledge station, TX” StataCorp. LP.</p> <p><a rel="nofollow"></a><strong>Result:</strong> There were 39,629 deliveries in the study period with majority being vaginal deliveries 64.3% (25,470/39,629). There were 105 emergency peripartum hysterectomies in the same period making the rate 2.6 per 1000 deliveries. Majority 68.5% (72/105) were not booked. The most common indication for emergency peripartum hysterectomy were uterine rupture 60% (63/105), postpartum hemorrhage from intractable uterine atony 21.9% (23/105) and accreta with or without previa 14.7% (14/105); but for those booked&nbsp; were postpartum hemorrhage 33.3% (11/33), accreta with or without previa 30.3%(10/33), uterine rupture27.2% (9/33) . Eighty-eight mothers had one or more post op complications with the most common complications documented being anemia (80.9%), puerperal fever (12.4%), acute kidney injury (9.5%), and relaparotomy (6.7%). &nbsp;The most common intraoperative iatrogenic injuries were bowel injury 2 out of 105(1.9%) and one ureteral transection (0.9%). &nbsp;&nbsp;There were 5 maternal deaths making the case fatality rate 47.6 per 1000. Neonatal outcome was registered for 102 cases of which 53(52%) were stillbirths.</p> <a rel="nofollow"></a><strong>Conclusion: </strong>uterine rupture, postpartum hemorrhage and accreta were the main reasons for emergency peripartum hysterectomy.