A Ten-year Review of Emergency Peripartum Hysterectomy in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi
Abstract:
Background: Emergency peripartum hysterectomy is a live saving procedure often used as a last resort when conservative measures fail in management of some obstetric complications. Objective: To determine the prevalence, indications, complications and feto-maternal outcome of this procedure in Nnamdi Azikiwe University Teaching Hospital Nnewi (NAUTH).
Methods: This is a 10-year retrospective cross-sectional study of all cases of Emergency Peripartum Hysterectomy (EPH) managed at NAUTH, Nnewi, Nigeria between 1st May 2009 and 1st April 2019. All the cases within the study period were obtained from the labour ward theatre register. The case notes of the patients were retrieved from the Medical records department. Information relating to age, parity, gestational age, booking status, indication and type of hysterectomy, complications, and outcome were noted and evaluated. The data were processed using Microsoft excel and exported to Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp.) for analysis
Results: During the 10-year study period, 34 (0.47%) EPH were performed out of 7,185 deliveries, however, the case files of only 31 patients (91.2%) were available for the study. Of these 31 cases; 6 (19.4%) were following vaginal delivery; 9 (29%) following a caesarean section and 16 (51.6%) were following an exploratory laparotomy for uterine rupture. Overall prevalence was 4.7 per 1,000 deliveries (1 in 211 deliveries). Twenty-two (71%) of the patients were unbooked. Uterine rupture (35.4%) was the commonest indication followed by uterine atony (25.8%) and placenta previa (22.5%). The commonest complications were anaemia (90.3%), febrile episodes (48.3%) and disseminated intravascular coagulopathy (22.5%). Subtotal abdominal hysterectomy was performed in 67.7% of the cases. There were 4 maternal mortalities (12.9%), whereas perinatal mortality was 11 (35.4%).
Conclusion: Emergency peripartum hysterectomy is a lifesaving alternative when conservative modalities fail and is associated with perinatal and maternal morbidity and mortality. Women should be encouraged and enlightened on the
