Emergency Peripartum Hysterectomy And Its Outcome In Ilorin, Nigeria

Emergency peripartum hysterectomy is a challenging but life-saving procedure associated with maternal morbidity and mortality.OBJECTIVES: To estimate the incidence, determine the factors associated with peripartum hysterectomy and determine the outcomes of the procedure METHODS: We analyzed retrospectively cases of emergency peripartum hysterectomy performed at University of Ilorin Teaching Hospital over a 15 year period.RESULTS: There were 38 emergency peripartum hysterectomies performed over this period. The incidence was 155 per 100,000 deliveries. The maternal mean age was 31.03 ±6.54 years, the mean parity was 3.80 ±1.88, range 0-7, while 20 (52.6%) had previous CS scar. While 19 (54.3%) had an abdominal delivery (out of whom 16 had ruptured uterus).The mean pre-operative Packed Cell Volume (PCV) was 16.7% (±5.8). All the patients had blood transfusions, the mean number of units transfused was 3.1 (±0.8) units. The mean estimated blood loss (EBL) at surgery was 1.6 (±1) liters, the mean duration of surgery was 136 (±36) minutes and subtotal hysterectomy was the procedure carried out in 35 (92.6%) of cases. Maternal deaths occurred in 10 (26.3%). The maternal morbidities recorded included 19 cases (50%) of post partum fever/sepsis. The perinatal mortality was 63.9%. The pre operative PCV and the estimated blood loss at surgery were significant factors that influenced whether the parturient woman survives or not.CONCLUSION: Peripartum hysterectomy is a life saving procedure whose incidence and the high morbidity and mortality associated with it in developing countries must be reduced. The high morbidity and mortality are largely due to the poor preoperative state rather than the surgery itself.