Rising Trend of Peripartum Hysterectomy-Indication and Outcome

Abstract

Background: Peripartum hysterectomy is a life-saving surgery performed during or after childbirth when severe bleeding cannot be controlled. Common indications include placenta praevia, uterine atony, and rupture. While essential in emergencies, it carries high risks and affects future fertility and maternal health. Methods: It was a cross-sectional study conducted in the Department of Obstetrics & Gynaecology, SSMCH between the periods of 1st January 2014 to 31st December 2014. Peripartum hysterectomy was done in 30 cases. Subjects were selected purposively according to the availability of the patients. Results: In the present study, the highest incidence of peripartum hysterectomy was observed in women aged 30–34 years, with the majority being multiparous (30% were para ≥4). Most patients (60%) had no history of antenatal checkups. Deliveries occurred at terms in 40% of cases, with 26.7% preterm and 33.3% post-term. A third had previous cesarean scars, and 10% had prior myomectomy. The leading indication was placenta praevia (60%), followed by uterine rupture (23.3%) and uterine atony (16.7%). Total hysterectomy was performed in 66.7% of cases. Common maternal complications included anemia (66.7%), hemorrhage (23.3%), UTI (33.3%), bladder injury and paralytic ileus (16.7% each), with a few experiencing ARF, cardiac arrest, coagulopathy, and wound disruption. Conclusion: Peripartum hysterectomy remains relatively high in developing countries, contributing significantly to maternal and neonatal mortality. Early decision-making, preparedness, and timely intervention are crucial. Improving antenatal care, identifying high-risk cases, enhancing blood transfusion support, and upgrading surgical skills are key to reducing complications and mortality.