Emergency peripartum hysterectomy: our 12-year experience

The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH).

We analyzed retrospectively 44 cases of EPH performed at tertiary obstetric center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH, and postoperative follow-up were obtained by analyses of hospital records.

The overall incidence of EPH was 0.48 per 1,000 deliveries during the study period. The most common indications of EPH were abnormal placentation (50 %), uterine atony (36 %) and uterine rupture (9 %). All patients who underwent EPH with abnormal placentation had one or more previous cesarean sections (CS) except one. In our series, 24 cases (54 %) underwent total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %), whereas subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %). Maternal mortality was seen in 2 patients (4.5 %). The causes were disseminated intravascular coagulation in one and adult respiratory distress syndrome in the other patient. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4 and prematurity in 3 patients.

In our series, abnormal placentation was the most common indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.