RESUMO
To determine the incidence, indications, complications and associated risk factors with emergency peripartum hysterectomy at El-Sahel Teaching Hospital, Cairo, Egypt. This is a retrospective study of 48 cases of emergency peripartum hysterectomy done from January 2000 to December 2009. 48 Patients of emergency peripartum hysterectomy were identified among 35,576 deliveries and the incidence rate was [0.13%]. Uterine atony 23 [47.9%], uterine rupture 15 [31.3] and placenta previa with accreta 10 [20.8%] were the most common indications of hysterectomy. Of the atony group, 18 bilateral uterine arteries [78%] and 13 bilateral internal iliac arteries ligation [57%] were performed as conservative surgery before proceeding to hysterectomies. In placenta previa with accreta group, the prior cesarean deliveries were higher compared to both atony and uterine rupture groups and that variable was statistically significant. 16 patients [33.2%] were complicated by disseminated intravascular coagulopathy [11/23 patients in atony group [47.8%], 4/15 patients in uterine rupture group [26.7] and one/10 [10%] in placenta previa with accrete group]. Uterine atony group received the highest volume of transfusion [packed red cells and fresh frozen plasma]. Differences in both gestational age [p<0.01], previous cesarean section [p<0.05] and fetal weight [p<0.05] between the three groups were significant. Placenta previa with accreta group had the highest rate of previous cesarean sections [2 +/- 1.4] suggesting a higher incidence of this complication with repeated cesarean sections. Uterine atony is still the main indication of peripartum hysterectomy. Careful prenatal care is needed for women who are at risk of postpartum hemorrhage. Cesarean deliveries of patient with suspected placenta accreta, specifically those performed due to placenta previa in women with a previous uterine scar, should involve specially trained obstetricians. In addition, detailed informed consent about the possibility of emergency peripartum hysterectomy and associated morbidity should be obtained