Peripartum hysterectomy for primary postpartum hemorrhage:

The aim of the study was to estimate incidence, indications, risk factors and operative morbidity and mortality in pregnant women undergoing emergency peripartum hysterectomy (EPH) in ten years at a community based academic medical center. We conducted a retrospective cohort study of 23 cases of Emergency Peripartum Hysterectomy (EPH) in a total of 61820 deliveries in ten years at Dezyani women Hospital between years 2000-2009 in (Gorgan) Iran. Emergency peripartum hysterectomy was defined as one performed for hemorrhage, unresponsive to other treatment less than 24 hours after delivery. For each case a form with question about dermographic data obstetrical history indication of surgery-the type of hysterectomy and complication was completed. There were 23 Peripartum Hysterectomy in61820 deliveries, so the incidence of EPH in total number of deliveries was 0.37 per 1000. 19 hysterectomies were performed followed a ceasarean sections (relative risk =15) and 15 patients had prior ceasarean section (relative risk =12) and 15 cases with placenta previa (relative risk =600). The indications for the hysterectomy were 15 cases with abnormal placentation (64%), 2 cases with ruptured uterus (9%), 4 cases with atonic uterus (18 %) , and 4 cases with hemorrhage during cesarean section (9%).Abnormal placenta was the most common indication in multiparous women and uterin atony in primiparous (Table 2).There was one maternal death (4.34%). Intra – and postoperative complications were prevalent, including: disseminated intravascular coagulation (2 cases), cardiac arrest (1 case), bladder injury (2 cases) that repair intraoperative, fibrile morbidity (3 cases), intensive care admission (2 case) and one case of septicemia with ATN accompanied with pulmonary embolism .