Emergency Peripartum Hysterectomies at Muhimbili National Hospital; Tanzania: A Review of Cases from 2003 to 2007

Abstract:A retrospective review of all cases of emergency peripartum hysterectomy performed between January 1; 2003 and December 31; 2007 at Muhimbili National Hospital was done to determine the incidence; indications and complications; background characteristics; antenatal care attendance; referral status; and maternal and foetal outcomes. There were 55;152 deliveries during the study period and 165 cases of emergency peripartum hysterectomy; giving the incidence of emergency peripartum hysterectomy of 3 per 1000 deliveries. The main indication was uterine rupture (79) followed by severe post-partum haemorrhage due to uterine atony (12.7). The case fatality rate was 10.3 where as perinatal mortality rate was 7.7 per 1000 deliveries. The common complication identified intraoperatively was severe haemorrhage which accounted for 39.4 where as intensive care unit admissions (14.4) and febrile morbidity (12.4) were common after the operation. Blood was ordered in all cases but in 31 cases it was indicated that it was not available. Seventy nine patients received blood transfusion with the maximum number of units given to one patient being eight. Twenty two patients were given fresh frozen plasma (FFP); the median number of units given was two (range = 1- 6). In conclusion; emergency peripartum hysterectomy is a life saving procedure and very common at MNH. The most common indication was ruptured uterus followed by severe postpartum haemorrhage. More than half of the patients underwent emergency peripartum hysterectomy were referred from other health facilities with ruptured or suspected ruptured uterus. The procedure was associated with unacceptably high maternal and perinatal morbidity and mortality

Accuracy in Diagnosis of Postpartum Haemorrhage Using Visual Estimation of Blood Loss versus Change in Haematocrit in a Tertiary Teaching Hospital in Tanzania

Abstract:Postpartum haemorrhage is the leading cause of maternal death in the developing country and yet is poorly diagnosed due to inaccurate measurement of blood loss following delivery. A study was carried out at Muhimbili National Hospital (MNH) Tanzania between October 2005 and January 2006 to determine the accuracy of visual estimation of blood loss (VEBL) in comparison to laboratory measurement of blood loss in diagnosis of primary postpartum haemorrhage (PPH). A total of 426 pregnant women who were in active phase of labour were recruited and their venous blood was drawn for estimation of haematocrit before delivery and 12 hours thereafter. Active management of third stage of labour was conducted by giving 10IU of oxytocin (intramuscularly or intravenously) and this was followed by visual estimation of blood loss. The proportion of patients who developed PPH was then determined by both methods. The mean duration of third stage of labour was 8.3 minutes and mean blood loss was 164.9ml. The prevalence of PPH was 8.9 and 16.2 by VEBL and changes in haematocrit; respectively. Change in haematocrit in diagnosis of PPH was found to be more accurate; specific with high positive predictive values compared to VEBL. The need for additional uterotonics was 5.8 and the commonest labour complications associated with PPH were second degree tear; retained placenta and EUA for continued bleeding. In conclusion; VEBL using calibrated vessel will increase accuracy where conventional method using non calibrated method is used for diagnosis of PPH. Service providers working in labour wards need to be trained on how to estimate blood loss using simulated methods so as to increase their long term memory and accuracy in diagnosis of post-partum haemorrhage; hence provision of immediate intervention