Maternal and Neonatal Outcomes Following Peripartum Hysterectomy in Teaching Hospitals of Mashhad University of Medical Sciences

Objective: The aim of this study was to determine the frequency, indications, risk factors and complication of Emergency Peripartum Hysterectomy (EPH) in our tertiary level teaching hospital, Qaem and Imam Reza.Methods & Materials: A cohort analysis was conducted of 103 cases of EPH performed at the Qaem and Imam Reza Hospital from March of 2014 to June of 2017 inclusive. EPH was defined as one performed after 20 weeks gestation for uncontrollable uterine bleeding not responsive to conservative measures occurring at the first 24 hours of delivery. Maternal characteristics of the age, education, gravidity, previous cesarean section, the index pregnancy and delivery, indications for EPH, operative and postoperative complications, maternal and neonatal outcome were acquired by the hospital records. Then data was analyzed by Spss 16.Results: There were 103 EPH out of 17457 deliveries, for a frequency of 5.9 per 1,000 deliveries during the study period. 102 EPHs were performed after caesarean delivery (CS) and one after vaginal delivery. The mean of gravidity of patients was 3.7 ±1.3 times. 91.3 % of patients who underwent EPH with abnormal placentation had at least one previous CS. 30.1% had previous history of uterine curettage and only one patient (1%) underwent myomectomy before. The most common indications were abnormal placentation (86.4%), followed by uterine atony (5.9%), and uterine rupture (1%) and uterine vessels abnormality (1 %). The most common morbidity after EPH was anemia (80.6%) followed by bladder laceration ( 24.3%), ureter damage (1.9%), fever (12.6%), infection (5.8%), disseminated intravascular coagulopathy (1%), pulmonary thromboembolism (1 %). 12.6% of patients underwent re-laparotomy and 5.8% of patients were readmitted into the hospital after discharge. The mean number of hospitalization was 6.6± 5.2 days and 40.8% of patients admitted to Intensive care unit. There was no maternal mortality among our patients and perinatal mortality was 8.7%. 28.2% of the newborns were admitted to NICU. 19.4% of the mothers were not successful to breastfeed their children.Conclusion: In our study, abnormal placentation especially placenta acereta causing severe hemorrhage was the most common indication for EPH. Previous CS was a risk factor for EPH and in particular for pathological adherence of the placenta. The morbidity associated with EPH is considerable.