Peripartum hysterectomy is a life saving procedure performed for severe obstetric complications such as major obstetric haemorrhage, abnormally invaded placenta , uterine rupture or sepsis.

Objectives:

1. To review the epidemiology of peripartum hysterectomies performed over a period of ten years from January 2012 to December2021

2.  To determine the trends in peripartum hysterectomies by comparing two different time periods 2012-2014 and 2019-2021

Materials and methods:

In this retrospective descriptive study, the case records of peripartum hysterectomies performed at Institute of maternal and childhealth, Goverment Medical College, Kozhikode between January2012 and December2021 were analysed. Results for 2012-2014 and 2019-2021 were compared to identify the changing trends . Demographic and clinical features associated with peripartum hysterectomies were assessed.

Results:

Total number of deliveries for 10 years was 147272 , of which 53975 (36.64%) women underwent caesarian section. Total number of peripartum hysterectomies was 312 with incidence of 2.12 per 1000 deliveries. Comparing the data between 2012-14 with 2019-21, incidence was 2.11 and 2.45 per 1000 deliveries respectively. Demographic variables in age, parity and gestational age at delivery did not differ between two periods. Placenta previa was the commonest indication for peripartum hysterectomies in both periods but it increased from 58 (58.58%) to 70 (81.39%). Atonic post partum haemorrhage decreased from 18.18% to 10.46%  and rupture uterus decreased from 11.11%  to 4.04% respectively during 2012-14 and 2019-21. Classical caesarian followed by hysterectomy in 53 cases(61.62%) during 2019-21 where as only 6 cases(6.06%) during 2019-21.

Complications:

Coaglopathy was present in 9.09% and need for relaparotomy in 2.02% cases in 2012-14 period, but no cases during 2019-21. Inadvertent bladder opening in 7(7.07%) cases during 2012-14 where as  during 2019-21 it was 15(17.86%) which is higher. Other complications like febrile morbidity and wound sepsis were comparable in both periods. Number of units of blood and blood products received was less during 2019-21 period, 56(65.11%) received only1-3 units where as 48(48.48%) received more than 3units during the period 2012-14. Post operative hospital stay was 9-11 and 5-7 days during 2012-14 and 2019-21 respectively.

Conclusion:

Incidence of peripartum hysterectomy is increased from 2.11 to 2.45 pre 1000 deliveries from 2012-14 to 2019-21 period. There is an increasing trend in the occurrence of placenta previa accreta which is the most common indication for hysterectomy during 2019-21. Classical caesarian section followed by hysterectomy in placenta previa accreta can reduce haemorrhage and need for transfusions.

To be updated