Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : March | Volume : 11 | Issue : 3 | Page : QC01 - QC03

Emergency Peripartum Hysterectomy: Indications and Outcome in a Tertiary Care Setting

Anshuja Singla, Rajlaxmi Mundhra , Latika Phogat, Sumita Mehta, Shalini Rajaram

1. Assistant Professor, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. 2. Ex-Senior Resident, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. 3. Ex-Senior Resident, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. 4. Specialist, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India. 5. Director Professor, Department of Obstetrics & Gynaecology, UCMS & GTB Hospital, Delhi, India.

Correspondence Address :
Dr. Rajlaxmi Mundhra
Ex-Senior Resident, Department of Obstetrics & Gynecology, University College of Medical Sciences and
Guru Teg Bahadur Hospital, Delhi-110095, India.
E-mail: Rmundhra54@yahoo.com

Abstract

Introduction: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving procedure, mostly reserved for conditions deemed to be serious and life threatening, and not amenable to conservative methods. In the present scenario, the advent of newer medical and conservative surgical methods for controlling obstetric haemorrhage has influenced the incidence, trend and the outcomes of the procedure.

Aim: To evaluate the demographic profile, indications, operative details, maternal morbidity and mortality and neonatal outcomes of women undergoing EPH.

Materials and Methods: A descriptive analysis of case records of women who underwent EPH between September 2006 to July 2014, at Guru Teg Bahadur Hospital Delhi, India was done. Data were collected from the medical records department.

Results: A total of 194 cases (n) were identified among 1,00712 deliveries, an incidence of 1.92 per 1000 deliveries. Majority of the women were unbooked i.e., they did not receive any form of antenatal care and were gravida 3 and above. The indications were atonic PPH in 89 (45.87%), rupture of unscarred uterus in 36 (18.56%), morbidly adhered placenta in 30 (15.46%), scar rupture in 20 (10.31%) and gangrenous uterus 19 (9.79%). The mean blood loss was around 1.6±0.45 litres. Approximately 14% cases underwent stepwise devascularisation prior to hysterectomy and in only 2% women, B-Lynch suture was applied. Thirteen (6.7%) cases had bladder injury and 22 (11.34%) needed re-laparotomy for hysterectomy. Around 76 (39%) women were shifted for ICU care. Nineteen (9.79%) women developed Disseminated Intravascular Coagulation (DIC). The case fatality rate was 7.2% and perinatal mortality was 30%.

Conclusion: Atonic PPH remains the leading cause of EPH in our analysis. Surprisingly rupture of unscarred uterus was more common compared to scar rupture. Creating awareness among women to seek health services in time with facilities for early referral, teaching younger obstetricians with conservative surgical procedures like stepwise devascularisation steps and compressive sutures should be of utmost priority.

Keywords

Atonic PPH, Compressive sutures, Obstetric hysterectomy

How to cite this article :

Anshuja Singla, Rajlaxmi Mundhra , Latika Phogat, Sumita Mehta, Shalini Rajaram. EMERGENCY PERIPARTUM HYSTERECTOMY: INDICATIONS AND OUTCOME IN A TERTIARY CARE SETTING. Journal of Clinical and Diagnostic Research [serial online] 2017 March [cited: 2017 Mar 24 ]; 11:QC01-QC03. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=March&volume=11&issue=3&page=QC01-QC03&id=9347

DOI and Others

DOI: 10.7860/JCDR/2017/19665.9347

Date of Submission: Feb 20, 2016
Date of Peer Review: Apr 13, 2016
Date of Acceptance: Sep 12, 2016
Date of Publishing: Mar 01, 2017

Financial OR OTHER COMPETING INTERESTS: None.

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