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Category: Volume 08 Issue 06 June 2020
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Title: Emergency Peripartum Hysterectomy: A Comparative Study of total verses subtotal hysterectomy in cases of abnormal placentation in a tertiary centre

Authors: Dr Ruchi Prasad, Dr Rupam Sinha, Dr (Prof.) Chandra Kiran

 DOI: https://dx.doi.org/10.18535/jmscr/v8i6.13

Abstract

 

Objective: To evaluate incidence, indication, risk factors and effectiveness of total verses subtotal hysterectomy as emergency peripartum hysterectomy (EPH) in cases of abnormal placentation in terms of patient outcome in form of morbidity and mortality.

Material and Methods: This is a 10 year retrospective case study series after thorough examination of case sheets of women who underwent emergency peripartum hysterectomy between January 2008 to December 2018 in department of obstetrics and gynaecology, Patna Medical College and Hospital, Patna after taking approval from the ethics committee. Patient case sheets were studied thoroughly to determine incidence, indication, risk factors, type of hysterectomy, complications and morbidity and mortality of patients of emergency peripartum hysterectomy.

Result: In our tertiary centre a total of 1250 cases of abnormal placentation of various types were admitted between gestational ages of 28 to 41 weeks between January 2008 to December 2018 in the labour room ward mostly with complaints of painless vaginal bleeding. Of 1250 cases 1150 (92%) underwent caesarean section (CS) and only 100(8%) were delivered vaginally. Out of 1150 caesarean section about 126 (10.0%) underwent emergency hysterectomy. The incidence of EPH in our study was 1.00 per 1000 deliveries. EPH was more common after CS deliveries than vaginal deliveries. Out of 126 emergency peripartum hysterectomy 68(53.9%) underwent subtotal hysterectomy and 58 (46.0%) underwent total hysterectomy. The most common indication for EPH was abnormal placentation 110(87.3%) and uterine atony 16(12.6%). Abnormal placentation included placenta previa, accrete, increta and percreta. In our study of EPH, previous CS was strongly associated with abnormal placentation. The risk factors included previous CS, scarred uterus, multiparity, older age group. There were 5 maternal deaths after EPH. Maternal morbidity occurred in 22 (17.4%) patients. Most common complication were mild to severe coagulopathy 18 (14.2%) and injury to urinary tract 3(2.3%).In some women more than one conservative procedure was performed. The decision to perform subtotal to total hysterectomy was influenced by the patient’s condition.

Conclusion: Abnormal placentation was most common indication to perform EPH. There was no statically significant difference between subtotal versus total hysterectomy with respect to age, parity, previous caesarean, operative time, blood transfusion, intra and post operative complications.

Keywords: Emergency peripartum hysterectomy, abnormal placentation.

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Corresponding Author

Dr Ruchi Prasad

Senior Resident, Department of Obst. & Gynae, Patna Medical College and Hospital, Patna