Emergency postpartum hysterectomy

Twenty-two deliveries were followed by emergency postpartum hysterectomy among 109,842 deliveries in the last 10 years, an incidence of 1 in 4992 deliveries (20/100,000). The leading causes of emergency postpartum hysterectomy were uterine rupture in 8 (36.3%), uterine atony in 7 (31.8%), and abnormally adherent placenta in 6 (27.3%) patients. Five of the uterine rupture cases followed previous cesarean births, whereas the other 3 followed dystocia. Of the 7 patients with uterine atony, 4 were after vaginal delivery and 3 were after cesarean birth. Of the 6 patients with adherent placenta, 4 had repeat cesarean deliveries and the other 2 were subjected to cesarean section for postterm pregnancies. The maternal mortality rate was found to be 4.5% (1/22). The perioperative morbidity included blood transfusion in 72.2%, febrile morbidity in 40.9%, and wound infection in 13.6% of the patients. Fetal mortality rate was 45.4%.