Evaluation of The Emergency Peripartum Hysterectomy Cases: Experience of 5 years

Objective: The purpose of this study is to evaluate the emergency peripartum hysterectomies performed due to obstetric complications. Methods: We analyzed retrospectively 18 cases of emergency peripartum hysterectomy that were performed at Cerrahpafla School of Medicine, Department of Obstetrics and Gynecology from January 2006 to December 2010. The incidence, demographic characteristics, associated risk factors, indications of hysterectomy, peripartum complications, maternal morbidity and mortality of the cases were analyzed retrospectively. Results: Emergency peripartum hysyerectomy performed in 18 cases. The overall incidence of emergency peripartum hysterectomy was 2.9 per 1,000 deliveries. The indications of hysterectomy were identified as 6 cases (33.6%) placenta insertion anomalies, 5 cases (27.7%) placenta previa, 4 cases (22.2%) uterine atonia, 2 cases (11.1%) uterine rupture, and 1 case (5.6%) with an adnexial mass respectively. The emergency peripartum hysterectomy was done in 4 of the cases (22.2%) after vaginal delivery and 14 of the cases (77.7%) during cesarean section. 14 cases (77.7%) were underwent total, 4 cases (22.2%) were underwent subtotal hysterectomy. During the operation, urinary complications occurred in 5 cases (27.7%). In 3 cases (16.6%) relaparatomy was performed. Maternal and fetal mortality occured in 1 case (5.5%). Conclusion: In our study, the most common indication for emergency peripartum hysterectomy was placental insertion abnormalities. Together with a significant increase in cesarean rates, significant increases in the frequency of plasenta inserton abnormalities is noteworthy. Cases of pregnant women who had placenta previa and prior cesarean section, the placenta should be carefully evaluated in terms of placenta insertion abnormalities. Entering the risk group of pregnant women, the centers which have adequate staff and equipment to be recommended for delivery. As a result; emergency peripartum histerectomy is a procedure with high mortality and morbidity but is life-saving when performed at suitable time.