Emergency Peripartum Hysterectomy In Mendefera Hospital-Case Control Study

Abstract Background Emergency peripartum hysterectomy is a life-saving procedure which involves the surgical removal of uterus and is usually performed for uncontrollable maternal haemorrhage when all other conservative management has failed. The aim of this study was to determine the incidence, indication, risk factors and perinatal/maternal outcome related to EPH performed in Mendefera Regional Referral Hospital Methods Case-control study was carried out in women, who underwent EPH over a period of almost 8 years. Controls were women, who had spontaneous vaginal delivery or were delivered by Caesarean section, without EPH. The findings were analyzed using Stata 14. Results During the study period, there were a total of 15,527 deliveries and 31 cases of emergency peripartum hysterectomies, giving an incidence of 2 per1000 deliveries. The mean age, parity, and hospital stay of the cases was 31.5, 4.0 and 5.5 respectively. The main indications for the procedure were uterine atony (38.7%) and uterine rupture (25.8%). Factors showing a significant association with EPH were: being 40 + years of age (OR 10.6; 95%CI 1.5–76.1), being grand multiparous (OR 8.0; 95%CI 2.1–30.4) and CS on the index pregnancy (OR 16.6; 95%CI 7.80-35.95). Subtotal hysterectomy was performed in majority (74%) of cases. The case fatality rate and stillbirth rate was 13% and 34.4% respectively. Conclusion The incidence of EPH in our institution is very high and fetal outcome was poor. The commonest indication for EPH was severe hemorrhages most notably caused by uterine atony or uterine rupture, which are largely preventable.