Peripartum Hysterectomy for Massive Obstetrics Haemorrhage in a Southern Nigerian Tertiary Hospital: A 10-Year Retrospective Review

Abstract

Background and objective: Severe obstetric haemorrhage is a leading cause of maternal

and perinatal mortality and morbidity. Emergency peripartum hysterectomy (EPH) is usually performed as the last resort to prevent maternal death due to massive obstetric bleeding. The aim of this review was to document the incidence, indications, and risk factors for EPH and to evaluate the maternal and perinatal outcomes in the tertiary hospital.

Methods: This was a 12 year retrospective facility based study. Cases of EPH were identified from the maternity register and the obstetric theater register. Their case notes were retrieved for in-depth analysis. Data were analyzed with SPSS version 24.

Results: The prevalence of EPH was 2.47 per 1000 deliveries. Abnormal placentation was the commonest indication. The median blood loss was 3000 ml. The procedure fatality rate was 10.6%. Non utilization of intensive care unit (ICU) services and delayed involvement of experienced surgeons were positively associates with higher procedure fatality rate (OR. 1.595, 95%CI: 1.310 – 1.941, P=0.049) and (OR. 2.810, 95%CI: 1.722 – 4.584, P=0.04) respectively. The perinatal mortality rate was 264.7 per 1000 live births. Uterine rupture (OR 12.65, 95%CI: 3.08 – 51.98) and lack of prior antenatal care (OR. 4.6, 95%CI: 2.06 – 8.96) were significant predictors of perinatal mortality.

Conclusion: Severe obstetrics haemorrhage necessitating EPH is a major risk factor for maternal and perinatal mortality and morbidity. Utilization of ICU services and timely involvement of highly stilled surgical personnel may improve maternal outcome, while antenatal services and safe delivery practices may prevent perinatal deaths.

Background and objective: Severe obstetric haemorrhage is a leading cause of maternal

and perinatal mortality and morbidity. Emergency peripartum hysterectomy (EPH) is usually performed as the last resort to prevent maternal death due to massive obstetric bleeding. The aim of this review was to document the incidence, indications, and risk factors for EPH and to evaluate the maternal and perinatal outcomes in the tertiary hospital.

Methods: This was a 12 year retrospective facility based study. Cases of EPH were identified from the maternity register and the obstetric theater register. Their case notes were retrieved for in-depth analysis. Data were analyzed with SPSS version 24.

Results: The prevalence of EPH was 2.47 per 1000 deliveries. Abnormal placentation was the commonest indication. The median blood loss was 3000 ml. The procedure fatality rate was 10.6%. Non utilization of intensive care unit (ICU) services and delayed involvement of experienced surgeons were positively associates with higher procedure fatality rate (OR. 1.595, 95%CI: 1.310 – 1.941, P=0.049) and (OR. 2.810, 95%CI: 1.722 – 4.584, P=0.04) respectively. The perinatal mortality rate was 264.7 per 1000 live births. Uterine rupture (OR 12.65, 95%CI: 3.08 – 51.98) and lack of prior antenatal care (OR. 4.6, 95%CI: 2.06 – 8.96) were significant predictors of perinatal mortality.

Conclusion: Severe obstetrics haemorrhage necessitating EPH is a major risk factor for maternal and perinatal mortality and morbidity. Utilization of ICU services and timely involvement of highly stilled surgical personnel may improve maternal outcome, while antenatal services and safe delivery practices may prevent perinatal deaths.