Obstetric hysterectomy: an emergency lifesaving procedure

Background: Although rare in modern obstetrics, emergency peripartum hysterectomy (EPH) remains a life-saving procedure, in the event of uncontrollable postpartum hemorrhage. Observations regarding the causes and outcomes of EPH provide valuable insights relevant to the current management perspectives in obstetrics. This study is intended to assess the contemporary prevalence, indications, and outcomes of EPH, at a Tertiary care referral institute. Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 3 years January 2011-December 2013, in the department of obstetrics and gynecology, at the KEM hospital, in Mumbai. Cases of EPH were analyzed for information, maternal age, parity, gestational age, type of delivery, indications for EPH and outcomes of the procedure. Results: The average annual incidence rate was1 per 1000 deliveries. 44% of the cases had an indication of abnormal placentation. 60% of the cases had caesarean section deliveries. Multiparity, previous LSCS, and gestation period of <37 weeks, were the commonly observed associations. 52% of cases required ICU admission. Maternal mortality rate was 8%. 20% of the cases had intrauterine fetal death. Conclusions: Abnormal placentation was evident as the leading cause of uncontrollable hemorrhage. This is possibly in view of a continual improvement in the management of uterine atony, reduced incidence of uterine rupture, and importantly, a rising trend of caesarean section delivery. This calls for more thoughtful considerations, regarding decisions for caesarean section delivery, in obstetrics practice.