Peripartum hysterectomy – an audit in Slovakia in 2007

Czech version

Authors: M. Mlynček ^1,2; M. Kellner ¹; P. Uharček ^1,2; M. Matejka ¹; E. Lajtman ¹; M. Boledovičová ²
Authors‘ workplace: Gynekologicko-pôrodnícka klinika Fakultnej nemocnice, Nitra ¹; Univerzita Konštantína Filozofa v Nitre, vedúci prof. MUDr. M. Mlynček, CSc. ²
Published in: Ceska Gynekol 2010; 75(2): 88-92

Overview

Objective:
An audit was performed to assess the number, indications and complications of peripartum hysterectomy at the departments of obstetrics/gynecology in Slovakia in 2007.

Design:
Observational descriptive study.

Setting:
Department of Obstetrics and Gynecology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra.

Method:
An official questionnaire of Slovak Society of Obstetrics and Gynecology was sent to all 63 departments of obstetrics/gynecology to find the number of peripartum hysterectomy performed in the year 2007. Differences between intrapartum and postpartum cases were compared.

Results:
44 from 63 institutions responded to the survey (response rate 69.8%). There were 38,485 deliveries and 24 cases of peripartum hysterectomies.

The incidence of peripartum hysterectomy was 0.62/1000 deliveries, 1 case occurred in 1,604 deliveries. 16 (66.7%) patients had a total abdominal hysterectomy with the remaining 8 (33.3%) having a sub-total hysterectomy. All operations were emergent. 18 procedures were performed during delivery and 6 in the postpartum period. Hypogastric artery ligation before hysterectomy were performed on 2 patients in the postpartum group. 20 of 24 (83.3%) patients delivered by cesarean section, three (12.5%) by spontaneous vaginal delivery and one (4.2%) with vaccumextraction. The indications for emergency peripartum hysterectomy were: placenta praevia 6 cases (25%), placental abruption with disseminated intravascular coagulation 6 (25%), placenta accreta 3 (12.5%), uterine atony 3 (12.5%), uterine rupture 3 (12.5%) and retroperitoneal haematoma 3 (12.5%). The youngest patient was 15 year-old, the oldest one was 39. After hysterectomy 10 (41.7%) women were admitted to the intensive care unit. There was no maternal mortality, but five newborns died due to perinatal asphyxia. There were more blood transfusions in the group of postpartum hysterectomies in comparison with intrapartum cases (4.0±1.3 transfusion units vs 9.1±3.5, p< 0.05), as well as the longer hospital stay (10.3±s4.2 days vs 19.1±5.3, p< 0.05).

Conclusions:
Peripartal hysterectomy is a dramatic but a life saving procedure. It is usually associated with significant maternal and fetal morbidity and mortality.

Every obstetric service should have access to a surgical team capable of performing emergency peripartal hysterectomy.

Key words:
cesarean section, haemorrhage, peripartum hysterectomy, risk factors.

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