Emergency peripartum hysterectomy - a challenge or an obstetrical defeat?

OBJECTIVES: Peripartum hysterectomy remains an obstetric nightmare. Most obstetricians consider it a defeat. The aim of our study was to assess the prevalence, indications, procedures and complications of emergency peripartum hysterectomy (EPH) in the 2nd Department of Obstetrics & Gynecology, Medical University of Warsaw during a 7 year period (2007-2013).

METHODS: A retrospective evaluation of 21,144 deliveries was performed. We analyzed all cases of EPH, including the maternal characteristics, obstetrical history, course of pregnancy and delivery, type of surgery and complications.

RESULTS: Nineteen peripartum hysterectomies were performed between January 1, 2007 and October 30, 2013 (0.9/1000), including 16 EPH (0.76/1000). The rate of EPH was between 0.66 and 1.0 per 1000 deliveries. The majority of the patients were multiparous (79.0%), and EPH was performed after at least one cesarean section (75.0%). Fifteen women had a singleton pregnancy and one woman had a triplet pregnancy. The mean gestational age was 34.2 weeks. The delivery mode was cesarean section in 93.8% of the cases. The most common reason for peripartum hemorrhage and the indication for EPH was abnormal placentation (75.0%). All patients underwent a total hysterectomy, including 43.8% during the same operation and 50.0% during a reoperation. There was no maternal death. The serious maternal complication rates were relatively low in our study and included one case of cardiac arrest that required cardiopulmonary resuscitation and one case of sepsis with pulmonary embolism.

CONCLUSIONS: EPH is typically performed as a result of massive hemorrhage associated with abnormal placentation, and it should be treated as a challenging, life-saving procedure.