Indication of emergency peripartum hysterectomy: review of 17 cases.
OBJECTIVE
The objectives were to determine the incidence, indications, associated risk factors and complications with emergency peripartum hysterectomy at King Abdulaziz University Hospital, Saudi Arabia.


METHODS
This is a retrospective analysis of 17 cases of emergency peripartum hysterectomy done from January 1, 1991 to December 31, 2002.


RESULTS
Seventeen patients of emergency peripartum hysterectomy were identified among 34,379 deliveries and the incidence rate was 0.5 per 1,000. Uterine atony 11 (64.7%, 9 without previa and 2 with previa) and followed by morbid adherent placenta with previa 6 (35.3%, 1 complete placenta accreta and 5 partial adherent placenta) was the most common indication of hysterectomy. Of the atonic group, 3 were primigravidae, 2 of 3 induced and 1 placenta previa. In morbid adherent placenta group the gravidity, previous abortions and prior cesarean deliveries were higher compared to the atonic group and were statistically significant. Conservative surgery performed in 6 (35.3%) patients before proceeding to hysterectomies, 3 (17.7%) patients had uterine artery ligation and 3 (17.7%) internal iliac ligation. Eight (47.1%) hysterectomies were subtotal. Nine (53%) patients developed disseminated intravascular coagulopathy (DIC) and one case (6%) had bilateral ureteric ligation and bladder injury. No maternal deaths occurred.


CONCLUSIONS
Uterine atony still is the leading cause of primary postpartum hemorrhage and the main indications of emergency peripartum hysterectomy. The combination of high parity, cesarean section, prior cesarean delivery and current placenta previa were identified as risk factors, and should alert the obstetrician that an emergency peripartum hysterectomy may needed. Although no maternal mortality occurred morbidity remained high.
Yamani Zamzami
Tarik Y
TY
Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, PO Box 80215, 21589 Jeddah, Saudi Arabia. tarikyamani@hotmail.com
D000328:Adult; D002585:Cesarean Section; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D008499:Medical Records; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D010298:Parity; D010923:Placenta Previa; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology