26-year review of emergency peripartum hysterectomy in a tertiary teaching hospital in Kuwait - years 1983-2011

ABSTRACT

To identify the risk factors and study the incidence, indications and complications of emergency peripartum hysterectomy [EPH]. This was a retrospective case-control study. The cases consisted of all women who underwent EPH between January 1983 and January 2011. Two controls per case were randomly selected from the remaining deliveries by using a random number table. Case records were retrieved from the medical records. Among 150,993 deliveries, there were 59 EPHs [cases], giving a rate of 0.390 per 1,000. Of the 59 cases, only 56 were analysed because 3 files were unavailable. These women were older [mean age 36 +/- 5.7 vs. 22 +/- 5.3 years, p < 0.01] and had delivered more than 1 child [p = 0.02]. Thirty-seven [66%] cases had had previous caesarean sections [CSs] and the number of CSs in this group was greater than in the controls [21%, p < 0.01]. More index cases had a history of atonic postpartum haemorrhage [46 vs. 4%, p < 0.001] and placenta praevia [34 vs. 4%, p < 0.01]. More cases than controls were delivered by CS [73 vs. 29%; p = 0.003]. The leading indications for EPH were haemorrhage due to uterine atony and placenta praevia. Independent risk factors were older age, multiparity, history of one or more CSs and placenta praevia. There were 2 maternal deaths from coagulopathy following massive obstetric haemorrhage. The main complications of EPH were febrile morbidity 12 [21%], wound infection 8 [14%] and bladder or ureteric injury 8 [14%]. CSs, especially repeat CSs in women with placenta praevia and persistent uterine atony, significantly increased the risks of peripartum hysterectomy