Key result
Emergency peripartum hysterectomy, driven primarily by abnormal placentation, is linked to ~8% maternal mortality.
Observational (n=90,956)
No
Abnormal placentation has emerged as the leading indication for emergency peripartum hysterectomy, underscoring the importance of reducing unnecessary cesarean deliveries to mitigate this risk.
High mortality demands clinical vigilance in abnormal placentation; observational data leaves open whether cesarean reduction lowers rates.
Introduction: Peripartum hysterectomy is a rare emergency obstetric surgery, usually performed in emergency situations such as massive obstetric hemorrhage.Emergency peripartum hysterectomy (EPH) can follow a vaginal delivery or a cesarean section.Materials and methods: Our study is retrospective.It is done at the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute (Tertiary care teaching hospital in South India) from January 2018 to December 2023.Results: Out of 90,956 deliveries, EPH was performed in 162 cases.0.178% is the incidence of EPH or it is about 1.8 per 1,000 deliveries.The commonest reason for EPH was abnormal placentation (43.8%).Atonic uterus (22.8%) and rupture uterus (20.3%) mostly secondary to scar rupture were the 2nd and 3rd most common causes of EPH.Discussion: Uncontrollable hemorrhage secondary to atonicity, ruptured uterus, and sepsis were once considered the principal risk factors for EPH.However, presently risk factors have changed and it is the abnormal placentation that considered to be the main indication for EPH.In this study, the most common indications of EPH were abnormal placentation, atonic uterus, ruptured uterus, and abruption.There were 13 maternal deaths (8.02%) in our study.A relatively low perinatal mortality rate (21.6%) is found in this study.Conclusion: Reducing the number of unnecessary cesarean deliveries, particularly repeat cesarean deliveries, in light of the evidence linking placental pathology with cesarean delivery, will help mitigate the number of EPH.
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Kumar et al. (2024) conducted an observational in Emergency Peripartum Hysterectomy (n=90,956). Emergency Peripartum Hysterectomy was evaluated on Incidence of EPH. Emergency peripartum hysterectomy occurred in 0.178% of 90,956 deliveries, most commonly due to abnormal placentation (43.8%), and was associated with an 8.02% maternal mortality rate.
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