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Mortality and morbidity after emergency peripartum hysterectomy in a provincial referral hospital in Papua New Guinea: A seven‐year audit
Author(s) -
Bolnga John W.,
Mola Glen D. L.,
Ao Paula,
Sapau Wendy,
Verave Ovoi,
Lufele Elvin,
Laman Moses
Publication year - 2021
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13286
Subject(s) - medicine , uterine atony , uterine rupture , obstetrics , incidence (geometry) , hysterectomy , maternal death , erythropoietin producing hepatocellular (eph) receptor , referral , medical record , caesarean section , retrospective cohort study , pregnancy , gynecology , pediatrics , population , surgery , uterus , physics , receptor , environmental health , family medicine , biology , optics , genetics , receptor tyrosine kinase
Background Emergency peripartum hysterectomy (EPH) is a life‐saving surgical procedure performed at the time of caesarean section or within 24 h of vaginal delivery and is usually a procedure of last resort in obstetric haemorrhage when other interventions fail. Aim To investigate the incidence, indications, risk factors and complications of EPH in a provincial referral hospital in Papua New Guinea (PNG). Materials and methods This was a seven‐year retrospective observational study investigating the rate of EPH at a provincial hospital between January 2012 and December 2018. Patient medical records that included socio‐demographics, obstetric risk factors, indications for EPH and maternal and perinatal outcomes were reviewed. Results Of the 19 215 deliveries during the study period, 26 women had EPH, giving an incidence of 1.35 per 1000 deliveries. The majority of women (18/26) were referred from peripheral health facilities. Overall, 21 women survived and five died (mortality index, 19%). Uterine rupture was the most common indication for EPH (13/26), and it was associated with a high maternal death rate of 15.4% (2/13) and significantly higher perinatal deaths when compared to babies born to mothers with other indications (13/13 (100%) versus 5/13 (38.5%); P = 0.002). Neonates born to mothers with uterine atony were more likely to survive (8/11 (72.7%) versus 0/15 (0%); P < 0.001), although maternal mortality was higher at 27.3% (3/11). Conclusion Uterine rupture and uterine atony after prolonged labour are common indications of EPH and associated with significant maternal and perinatal mortality. Improving pre‐hospital management of prolonged labour remains critical in PNG.