Abstract
Background: Emergency Peripartum Hysterectomy (EPH) is a major surgical procedure. There appears to be a
rise in the rate of emergency peripartum hysterectomy (EPH) in the developed world. Peripartum hysterectomy
is high risk but a life saving operation. It is usually associated with significant maternal and fetal morbidity and
mortality. Obstetricians should identify patients at risk and anticipate the complications, as early intervention and
proper management results in optimal outcome.
Objective: To determine the incidence, indications, risk factors, complications and management of EPH over the
last eleven years.
Study Design:A descriptive study.
Place and Duration of Study: All cases of EPH performed in the period between January 2001 and December
2011 were included in the study. Study was conducted at Railway Teaching Hospital, Rawalpindi (in northern
Pakistan).
Materials and Methods: Data of all the cases of EPH cases operated during the study period was collected from
the hospital obstetric record. Data of basic demographics, mode of delivery, maternal and fetal outcome along
with associated complications was collected and entered into the Statistical Package for Social Sciences version
14.0 (SPSS Inc., Chicago, IL, USA) for further analysis. Indications, pre-op planning, type of operation,
emergency decision, blood loss, transfusion, complications, were compared and cross-tabulated. Statistical
analysis included: Chi-square and Fisher exact tests, where appropriate, and two-sample t test.
Results: Total deliveries were 13560 in 11 years. Twenty Six EPH cases were performed among deliveries,
giving an incidence of 1.8 per 1000 deliveries i.e. one in 566 deliveries. The indications were uterine atony
(34.61%), ruptured uterus (23.07%) and cervical/vaginal tears (11.53%), placenta praevia (11.53%), invasive
placental adhesion [accreta, increta, percreta (11.53%)]. A significant association between previous uterine
surgery and abnormal placentation was shown (p=0.02), especially those with previous caesarean (p=0.003).
One maternal and six perinatal mortalities were recorded. Four perinatal deaths were of non booked patients,
handled by traditional birth attendants/private clinics. Out of two perinatal deaths of booked patients, one was
pre-term and other was delivered by forceps. Maternal morbidity was prevalent, including twenty three intensive
care admissions, three disseminated intravascular coagulopathies, three bladder injuries, three re-explorations,
multiple blood, FFPs & platelet transfusions, two pulmonary embolism & one cardio- respiratory failure. Maternal
death was of non booked patient with previous scar, home delivery, uterine rupture and brought to hospital with
un-recordable BPand very weak pulse.
Conclusions: Incidence of peri-partum hysterectomy is increasing. It is a major operation, and almost always an
emergency with significant blood loss. An early decision should be made to save life of the patient and prevent
complications. The most important risk factor for peripartum hysterectomy in our patients is hemorrhage, most
notably caused by uterine atony, uterine rupture, placenta previa and abnormally adherent placenta.
Saadia Sultana, Muhammad Nadim Akbar Khan, Shamsunnisa Sadia, Noor Mah khan, Fareesa Waqar, Azra Saeed, Umber Jalil. (2013) Emergency Peripartum Hysterectomy in Pakistan Railway Teaching Hospital Rawalpindi: Eleven Years Review, Journal of Islamic International Medical College, Volume-8, Issue-3.
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