title: Emergency peripartum hysterectomy in a tertiary care hospital in saudi arabia.
abstract: OBJECTIVE
  Post-partum hemorrhage remains an important cause of significant maternal morbidity and mortality throughout the world. The objective of this study was to review the incidence, indications, predisposing factors, and associated complications of emergency peripartum hysterectomy.
  
  
  METHODS
  This is a retrospective observational study done in a Tertiary Care Center, Riyadh, Saudi Arabia, between 1983 and 2006. Women who underwent emergency peripartum hysterectomy after cesarean delivery or following vaginal birth due to severe post-partum hemorrhage who did not respond to conservative treatment were included in the study. Data were abstracted from chart reviews. Descriptive analysis was carried out to summarize relevant variables. Primary outcomes included indications, risk factors, maternal morbidity, and mortality.
  
  
  RESULTS
  There were 66 emergency peripartum hysterectomies among 155,857 deliveries, which yielded an incidence of 0.04 %. Prior cesarean delivery was present in 88 % of the patients; a majority of the patients were grandmultiparous, Para > 6 (65 %). The incidence of hysterectomy after cesarean delivery was much higher than after vaginal delivery (0.3 vs. 0.01 %). Common indications included placenta accreta (65 %), uterine atony (27 %), and uterine rupture (8 %). The majority of the study cohort (64 %) had undergone total hysterectomy. Post-operatively, 25 patients (38 %) developed DIC, 32 (48.5 %) had febrile illnesses, and 22 (33 %) experienced injury to the urinary tract. The maternal mortality in this study was 4.5 %.
  
  
  CONCLUSIONS
  Hysterectomy for the control of obstetric hemorrhage is usually associated with significant mortality and morbidity. Prompt intervention to include peripartum hysterectomy may likely decrease the rate of maternal deaths and significant maternal morbidity.
authors.affiliation: Department of Obstetric and Gynecology, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia.
authors.forename: Mahfuza
authors.initials: M
authors.lastname: Begum
authors.affiliation: King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Alsafi
authors.affiliation: Department of Obstetric & Gynaecology, Saint Vincent Catholic Medical Center, New York, NY USA.
authors.forename: Jamil
authors.initials: J
authors.lastname: ElFarra
authors.affiliation: Epidemiology and Biostatistics, College of Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hani M
authors.initials: HM
authors.lastname: Tamim
authors.affiliation: Department of Obstetrics/Gynaecology/Newborn Care, University of Ottawa, Ottawa, ON Canada.
authors.forename: Tien
authors.initials: T
authors.lastname: Le
keywords: Emergency; Hysterectomy; Obstetric; Outcome; Risk factors