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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 15, Issue 3, July 2015 pp 505-509
A study of maternal mortality and morbidity observed in peripartum hysterectomy in a tertiary care center
B R Bhagat1, Mamta Kalsi2, Ajay Wakhloo3, Anna4, Shashi Gupta5
1Lecturer, 2Consultant, 3Assistant Professor, 4PG Student, 5Professor, Department of Obstetrics and Gynaecology
SMGS Hospital and Government Medical College, Jammu, J & K, INDIA.
Introduction: Peripartum hysterectomy is considered one of the most devastating complications in obstetrics resulting in high costs to health care system and adverse outcomes for women desiring to maintain fertility. Maternal moratilty rates associated with emergency hysterectomy ranges from 0-30% with higher rates in regions with limited medical and hospital resources. Even in countries with low maternal mortality rates, associated maternal can be high due to hemorrhage, blood transfusion, DIC, infection and potential injury to adjoining viscera. Amis and Objectives: To study the maternal mortality and morbidity observed in peripartum hysterectomy in a tertiary care center Material and Methods: The present observational study was conducted in the Post Graduate Department of Obstetrics and Gynecology, S.M.G.S Hospital. Government Medical College, Jammu, from November 2012 to October 2013. Total 40 cases of peripartum hysterectomy were enrolled in the study duration. A detailed history was taken of all cases. Maternal characteristics such as age, parity, gestational age, previous cesarean delivery, previous uterine curettage, history of ante partum bleeding, obstetric complication, mode of delivery and intrapartum complications were recorded on a prestructured proforma. Additional procedures performed prior to contemplating hysterectomy, need for blood and component transfusion, the indications for performing surgery, type, operating time, pre and post operative complications and number of hospitalization days were obtained. Post- operative examination of all cases was done. Monitoring chart in terms of vitals, input including crystalloids, colloids, blood and blood components and urine and drain site output were noted. All investigations done on admission for booked cases and before surgery for both booked and referred cases were also recorded on proforma. The collected data was displayed in percentages and represented with the help of appropriate tables and diagrams. Results: The survival rate observed after periparum hysterectomy was 90%. Four cases out of total 40 cases died in the due course of treatment. 45% patients underwent LSCS prior to hysterectomy. Most common indication of peripartum hysterectomy was rupture uterus accounting for 37.5% of the total hysterectomies. Morbidly adherent placenta was found to be the second most common cause. In 67.5% patients one or more fertility preserving, conservative procedures were tried before hysterectomy. All the patients were noted to have received blood transfusion during or in the immediate postoperative period where indicated. Almost all our patients (90%) experienced some form of complication. Wound infection was the most common complication, seen in 19 (47.5%) patients. Wound dehiscence occurred in 3 patients for which re-suturing were required. Three patients required re-laparotomy for post – hysterectomy hemoperitoneum. Maternal mortality occurred in 4 (10%) patients. Conclusion: Thus we conclude that although peripartum hysterectomy is a rare condition, it represents a catastrophic and sometimes fatal to a pregnancy for any woman. Wound infection, bladder injury, anesthesia complication and re-laparotomy were the common complication observed leading to high morbidity rate.