J Ayub Med Coll Abbottabad 2009;21(1) http://www.ayubmed.edu.pk/JAMC/PAST/21-1/Nusrat.pdf 48 EMERGENCY PERIPARTUM HYSTERECTOMY: FREQUENCY, INDICATIONS AND MATERNAL OUTCOME Nusrat Nisar, Nisar Ahmed Sohoo* Department of Obstetrics & Gynaecology, Isra University Hospital, Hyderabad, *District Coordinator for National Programme for FP & PHC Matiari, Sindh, Pakistan Background: Emergency Peripartum Hysterectomy (EPH), although rare in modern obstetrics, remains a life saving procedure in cases of severe haemorrhage. The aim of present study was to review the frequency, indication, associated risk factors, maternal morbidity and mortality associated with emergency peripartum hysterectomy in a private sector teaching hospital. Methods: This was a retrospective review carried out from August 2003 to September 2008. Main outcome measures were frequency, indications, associated risk factors and maternal morbidity and mortality associated with Emergency Peripartum Hysterectomy. Results: The frequency of emergency peripartum hysterectomy over a study period was 0.42%. Mean age and parity of patients was 30.9±5.0 years and 4.52±1.8 respectively. The mean gestational age at the time of delivery was 36±3.4 weeks. Nine (42.9%) patients had previous history of caesarean delivery. Main indication for EPH were rupture uterus 7 (33.3%), uterine atony 6 (28.6%), morbid adherence of placenta 5 (23.8%) and severe bleeding from placental bed in 3 (14.3%) patients. All woman required blood transfusion, 11 (52%) require ICU admission, 81% were anaemic, 3 (14.3%) developed DIC, 4 (19%) pulmonary oedema, febrile illness 6 (28.6%) and wound disruption was seen in 3 (14.3%). The maternal mortality occurred in 4 (19%) cases. Conclusion: Frequency of emergency peripartum hysterectomy is high in our set up. High parity, rupture uterus, increase number of caesarean deliveries and abnormal placentation was identified as risk factors for EPH. High frequency of maternal morbidity and mortality was observed in the present study. Keywords: Emergency Peripartum Hysterectomy, maternal morbidity, maternal mortality INTRODUCTION Emergency Peripartum hysterectomy is one of the life saving procedure performed after vaginal delivery or caesarean birth or in the immediate postpartum period in cases of intractable haemorrhage due to uterine atony, rupture uterus and placental disorders and it is usually reserved for the situations where conservative measures fail to control the hemorrhage. 1 In past the most common indications of EPH was atony and uterine rupture. 2,3 Recent reports shows that abnormal placental adherence/placenta previa is emerging as the major indication for EPH and is most likely related to increase in number of caesarean delivery observed over the past two decade. 4,5 Emergency Peripartum Hysterectomy is associated with severe blood loss, risk of transfusion, intraoperative complications and significant postoperative morbidity and mortality. 6–8 The high incidence of morbidity and mortality is reported from developing countries. 9 Several studies from different regions of Pakistan have reported different frequencies, indications and maternal outcome associated with Emergency Peripartum Hysterectomy. The purpose of present study was to determine the frequency, indications, associated risk factors and maternal morbidity and mortality associated with emergency peripartum hysterectomy in a tertiary care private sector hospital in Hyderabad, Pakistan. MATERIALS AND METHODS This retrospective review was carried out in the Department of Obstetrics and Gynaecology, Isra University Hospital, Hyderabad, Sindh from August 2003 to September 2008. All the patients who underwent Emergency Peripartum Hysterectomy were identified from the labour ward registers, operating room record books and intensive care unit registers. Emergency Peripartum Hysterectomy was defined as a hysterectomy performed for haemorrhage unresponsive to other treatment within 24 hours of delivery. The medical record sheets of all identified patients were reviewed regarding the maternal age, parity, socioeconomic status, antenatal booking status, gestational age at time of delivery, previous history of caesarean delivery, history of antepartum haemorrhage, mode of delivery, indication for peripartum hysterectomy, peripartum complications and maternal morbidity and mortality. All data gathered was entered and analysed using SPSS 12. RESULTS Over the study period, 21 emergency peripartum hysterectomies were performed at Isra University Hospital. During the same period total 4,923 deliveries including 2,778 caesarean and 2,145 vaginal deliveries were conducted.