Peripartum hysterectomy: two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa.
BACKGROUND
Obstetric haemorrhage is the leading direct cause of maternal mortality in South Africa.


OBJECTIVE
To determine the incidence, indications, associations and maternal outcomes of emergency peripartum hysterectomies.


METHODS
A descriptive and retrospective analysis of patients who had peripartum hysterectomy between 1(st) February 2007 and 31(st) January 2009 in Nelson Mandela Academic Hospital at Mthatha city.


RESULTS
The incidence of 0.95% of peripartum hysterectomies (n=63 or 9.5/1000 births) increased with the increasing maternal age from 0.121% at age of less than 20 years to 0.5% at age more or equal to 30 years. Similarly the incidence increased with parity from 0.332% for Primiparity to 0.468% at parity of four or more. The indications for the operation were uterine atony 19/63 (30.2%), secondary haemorrhage/puerperal sepsis 17/63 (27%) and ruptured uterus 16/63 (23.4%). The main intra operative complication was haemorrhage 13/63 (20.6%). Repeat laparotomy was done in 10/63 (15%) of patients due to haemorrhage. Admission to intensive care unit was 25/63 (39.7%). The case specific mortality rate was of 19 % (n=12). The main causes of death were hypovolaemic shock and septicemia.


CONCLUSIONS
The incidence of peripartum hysterectomies was high and was associated with ruptured uterus and puerperal sepsis which are preventable.
Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
J N
JN
Wandabwa
C
C
Businge
B
B
Longo-Mbenza
M L
ML
Mdaka
P
P
Kiondo
D000046:Academic Medical Centers; D000328:Adult; D003422:Critical Care; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D007431:Intraoperative Complications / Q000453:epidemiology; D008423:Maternal Age; D008485:Medical Audit; D058725:Peripartum Period; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
Hysterectomy; Peripartum; Ruptured uterus; Uterine atony; secondary haemorrhage