Emergency peripartum hysterectomy in a developing country.

BACKGROUND

Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure that is associated with maternal morbidity and mortality, especially in developing countries. The advent of newer medical and conservative surgical methods of controlling postpartum hemorrhage will influence both the rate and the outcomes of the procedure.

OBJECTIVE

To study the rate of EPH, the influence of sociodemographic characteristics on the rate of the procedure, the modality of treatment used in each of the indications, and maternal-fetal morbidity and mortality.

METHODS

We conducted a case-control study of 30 patients who underwent EPH between June 1, 2003, and 31 May 31, 2008, at Aminu Kano Teaching Hospital, Kano, Nigeria, a tertiary institution in a developing country.

RESULTS

The rate of EPH in this study was 4.0 per 1000 deliveries. Ruptured uterus (73.3%) was the most common indication. Factors showing a significant association with EPH were being 31 to 40 years old (OR 6.7; 95% CI 3.9 to 15.7), being para ≥ 5 (OR 4.1; 95% CI 1.87 to 9.1), having unbooked status (OR 9.1; 95% CI 3.6 to 24.9), and being in a low social class (OR 7.5; 95% CI 1.7 to 45.3). Ruptured uterus (OR 164.3; 95% CI 67.9 to 410.0) and placenta previa accreta (OR 36.1; 95% CI 10.0 to 117.3) were significantly associated with EPH. The most common morbidity was wound sepsis (60%). The case fatality rate was 13.3%, and perinatal mortality was 73.3%.

CONCLUSION

The rate of EPH in our institution is high, and maternal-fetal outcome is poor. Antenatal care and hospital delivery should be encouraged.