Emergency postpartum hysterectomy: a comparrison of postpartum and cesarean hysterectomy

Abstract

Background: Emergency postpartum hysterectomy is often performed for life threatening obstetric conditions, such as intractable hemorrhage or severe uterine infection those failed to conservative management. It included both postpartum hysterectomies that are done after vaginal delivery and cesarean hysterectomies, those that are done after cesarean delivery. The purpose of this study was to compare the difference of emergency postpartum hysterectomy in both groups.
Objective: To evaluate the incidence, maternal characteristics, outcome of delivery and hysterectomy, cause of emergency postpartum hysterectomy and complication of hysterectomy.
Research Design: A retrospective analytical study.
Setting: Department of Obstetrics and Gynecology, Surin Hospital.
Material and methods: Forty-seven pregnant women GA>28 weeks who underwent emergency postpartum hysterectomy within 24 hours after delivery at Surin Hospital during October 1, 2003 and September 30, 2010 were examined. Information obtained included a complete medical records and operating room registration records. Comparisons were made between postpartum and cesarean hysterectomy. For statistical analysis p-valve from Fisher Exact Test.
Result: There were 47 cases of emergency postpartum hysterectomy (15 postpartum hyster
ectomies and 32 cesarean hysterectomies) for a rate of 0.98 : 1,000 deliveries, 0.52 : 1,000 vaginal deliveries and 1.71 : 1,000 cesarean deliveries respectively. Overall, maternal age 32.94± 4.73 years gestational age 37.68 ± 2.96 weeks. The most common primary indication for hysterectomy was uterine atony (57.5%), follow by uncontrolled bleeding (17%) but pathological finding 46.8% was placenta adherent follow by gravid uterus 25.5%. The operation performed at nighttime 68.1%. Average operating time was 74.13 ± 28.21 minutes, average estimated blood loss was 2,606.38± 1,247.15 mL, average blood transfusion was 1,574.36 ± 1,054.94 mL, average estimated fetal weight was 2,712.34±949.49 grams, and average length of hospitalization was 5.21±1.97 days. A total hysterectomy was performed 61.7% (90.6% in cesarean hysterectomy an none in postpartum hysterectomy p=0.000). Postoperative complications were needed for blood transfusion 100% follow by respiratory support (on ETT and admitted in ICU) 27.7% Die 25.5% statistically significant difference between postpartum and cesarean hysterectomy (46.7% and 15.6% respectively p=0.034). Two maternal mortality were founded a day after hysterectomy.
Conclusion: Placenta adherent was the most common cause of emergency postpartum hysterectomy in both vaginal and cesarean deliveries. Die was founded in postpartum hysterectomy more than cesarean hysterectomy.