A RETROSPECTIVE STUDY OF INCIDENCE AND RISK FACTORS OF PERI-PARTUM HYSTERECTOMY AT A TERTIARY CARE CENTRE

Abstract

Background And Objectives-The reported incidence of peri-partum hysterectomy varies worldwide and it is around 10.1 per 1000 deliveries in India (1).Earlier it was believed that the incidence of peri-partum hysterectomy is higher in low income groups. But now it is being observed that the risk of landing into a peripartum hysterectomy is increasing in high income groups also due to the increasing rate of caesarean sections in them. Previous caesarean delivery increases the risk of placenta accreta spectrum disorders in the subsequent pregnancies. A systematic review emphasized that the rate of placenta accreta spectrum increases from0.3% in women with previous one caesarean delivery to 6.74% for women with five or more caesarean deliveries. (2). Other important risk factors for peripartum hysterectomy are intractable PPH following vaginal or caesarean delivery, rupture uterus, uterine perforation leading to septic abortion.

Methods- This is a retrospective study performed at Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow from January 2020 to December 2022. All women who delivered at our hospital and landed in peripartum hysterectomy or were referred to our hospital and landed in peripartum hysterectomy were included in the study. Their demographic characteristics including age, parity, previous deliveries were noted.  Indications of hysterectomy, per-operative and post-operative complications, course during hospital stay, neonatal outcome, need for ICU care were noted. The results were presented as percentage for categorical variables.

Results- During the study interval of two years 34 emergency peri-partum hysterectomies were noted. Number of deliveries noted in that interval was 14,204. The incidence of emergency peripartum hysterectomies at our hospital came out to be 2.39/1000 deliveries. The main indication for peripartum hysterectomy in our study was found to be rupture uterus (44.11%) followed by PPH (35.29%). Placenta accreta spectrum was identified in 14.7% cases.

Conclusion- It may be concluded that landing into a peri-partum hysterectomy is near miss experience for a pregnant woman. Adequate contraception facilities to limit family size, proper labour monitoring and timely referral of women are important factors that can significantly reduce the risk of a woman landing into a peri-partum hysterectomy.