Caesarean and post partum hysterectomy

Backgroun: Caesarean Hysterectomy is an emergency procedure and is performed in the event such as uterine rupture or uncontrollable postpartum hemorrhage. Postpartum hysterectomy can be performed a few hours of normal delivery, instrumental delivery or caesarean section or sometime may be done in puerperium. The objective of this study was to determine the incidence and causes of postpartum hemorrhage. The aim was to discuss the new trends of management of postpartum hemorrhage. Material and Method: A Retrospective study was performed in two units of Gynecology Department of Ayub Teaching Hospital from 1 st May 2001 to 31 st May 2003. Parameter analyzed were age, parity gravidity, social status, booking status type of operation, complication, and maternal and perinatal deaths. Results:. During two years 4895 deliveries were performed. A total of 35 cases underwent by caesarean and postpartum hysterectomy. 30 Women had subtotal and 5 had total hysterectomy. The most common indication for procedure were uterine rupture, uterine atony and intractable hemorrhage (89%). 85% of our patient were unbooked. 22 (62.85%) had intra operative & post operative complications. There were two (5.71%) maternal deaths and 22(62.85%) perinatal death. The patients who died were received in irreversible shock. Late arrival and non availability of blood were the two main factors in maternal mortality. Conclusion: Improving nutritional, educational status training of TBAs and antenatal booking can reduce the incidence and associated morbidity and mortality of postpartum hemorrhage. Emergency obstetric hysterectomy when performed in selected cases at an appropriate time can reduce the mortality