Nkwo E. C., Ekott M. I., Nkwo G. C. E. and Mbamba C.
The objective of this study was to determine the incidence, indications, associated socio-demographic variables, type of surgery and maternofetal outcomes of emergency peripartum hysterectomy (EPH).A retrospective analysis of all patients whohad emergency peripartum hysterectomy between 1st December 2008 and 31st December 2013 at the Federal Medical Centre(FMC) Umuahia was undertaken. Information on socio-demographic variables, indications for EPH, type of hysterectomy performed, cadre of surgeons, maternal and fetal outcomes were extracted and evaluated from case files. There were 9,478 deliveries and 36 emergency peripartum hysterectomies, within the study period, giving a rate of 3.8% or 4 in 1000 deliveries. The mean age of patients who had EPH were 31 ± 3.1 years. Majority (52.7%) were of low parity. Most (63.9%) were unbooked. Uterine rupture was the leading indication (69.4%) for EPH. Majority (80.6%) of the patients had subtotal abdominal hysterectomy. All the patients had blood transfusion. The commonest postoperative morbidities were anaemia (69.4%), pyrexia (50%) and wound sepsis (25%). Case fatality rate was 8.3%.In all cases, the cause of death was related to acute renal injury and disseminated intravascular coagulation (DIC). The perinatal mortality was high (61.1%).Uterine rupture was the leading indication for EPH in this study. Antenatal care booking, identification of high risk cases, early referral, prompt resuscitation, quick surgical intervention by an experienced surgeon as well as involvement of the haemotologist and nephrologist at an early stage are critical to reducing the incidence, morbidity and mortality of EPH in our centre.
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