Emergency Postpartum Hysterectomy : A 15-Year Experience at Srinagarind Hospital, Khon Kaen University

Abstract

Objectives To assess the incidence and factors affecting emergency postpartum hysterectomy.

Patients Cases were all patients undergoing emergency postpartum hysterectomy during 1981-1995. Controls were women who gave births before and after the cases of emergency postpartum hysterectomy.

Main outcome measures Data abstracted from medical record in term of maternal characteristics, route of delivery, indications for hysterectomy and outcomes including complications.

Results Emergency postpartum hysterectomy was performed on 45 cases atSrinagarind Hospital, Khon Kaen, Thailand, between January 1981 and December 1995, giving an incidence of 1 : 1,290 deliveries. Medical records were available for 42 cases. Uterine atony (64.3%) was the most common indication of emergeney hysterectomy followed by uterine rupture (23.8%) and placenta accreta (11.9%). The intraoperative and postoperative problems included accidental injury to bladder (1 cases), rectum (1 cases) and ovary (4 cases), febrile morbidity (18 cases) ; coagulopathy (8 cases) ; wound infection (1 case) and pneumonia (3 cases). There was one maternal death. Factors associated with emergency postpartum hysterectomy were the maternal age and the oxytocin induction of labour.

Conclusion Emergency postpartum hysterectomy is occasionally performed but leads to high morbidity. The incidence seems to increase with the modern obstetric management especially using oxytocin to induce labour.