Factors and outcome analysis of emergency peripartum hysterectomy in a tertiary care center catering to hilly terrain for a five-year period: a retrospective study

Abstract

Background: Emergency peripartum hysterectomy (EPH) is a life-saving surgery associated with significant morbidity and mortality. In the state of Uttarakhand, due to the hilly terrain and poor ante-natal awareness, type 1 and 2 delay is expected in seeking health care. Thus, the present study was conducted in a tertiary care hospital to evaluate the incidence, risk factors, indications, and outcomes of EPH.Methods: Medical records of 63 patients who underwent EPH from January 2015 to December 2019 were retrospectively analyzed for the patient characteristics, high risk factors, indications and type of hysterectomy and outcome.Results: The incidence of EPH at our institute was 2.78 per 1000 deliveries. Most patients (89.89%) were referred cases. There were 4 home deliveries and 4 patients referred for obstructed labour.  The average parity was 2.71±1.13. Thirty-four patients (53.97%) presented in the emergency department in shock. The leading indication was uterine atony (46.03%) followed by rupture uterus (26.98%) and placenta accreta spectrum (23.81%). All patients needed blood transfusion. Intensive care unit admission was required in 88.89%. The maternal mortality was 15.87%.  All the three levels delays contributing to poor outcome were identified. Conclusions: Uterine atony and rupture of non-scarred uterus due to obstructed labour were the prominent indications of EPH. Strengthening of referral system and timely referral of high-risk patients to a setup with facilities for management of high risk obstetric cases can play an important role in decreasing the incidence and morbidity and mortality of EPH.