July 2016 · Volume 5 · Issue 7 Page 2338 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Satia MN et al. Int J Reprod Contracept Obstet Gynecol. 2016 Jul;5(7):2338-2342 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Research Article Obstetric hysterectomy: an emergency lifesaving procedure Meena N. Satia*, Vibha More INTRODUCTION Making a clinical decision for an emergency peripartum hysterectomy (EPH) is amongst the most difficult surgical dilemmas, faced by an obstetrician. The clinical judgment, on the spot, is a decisive choice between saving a mother’s life and compromising on her reproductive capability. This is compounded by the unplanned nature of the surgery, and the patient’s compromised status due to blood loss. Although rarely necessary in modern obstetrics, EPH remains an invaluable life-saving procedure, demanding a sound clinical judgment and precision. EPH is a hysterectomy performed in the event of life- threatening haemorrhage, during or immediately following abdominal or vaginal deliveries, and following the failure of all conservative measures of achieving haemostasis. Commonly encountered indications that necessitate EPH include uterine atony, abnormal placentation, or uterine rupture. Although traditionally, uterine atony has been the leading indication for EPH, recent studies do suggest an increasing trend of abnormal placentation, associated with more frequent Caesarean section deliveries. 1,2 Since the obstetrics practice trends may significantly influence the need and outcome of EPH, a periodic Department of Obstetrics and Gynaecology, Seth G. S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India Received: 18 May 2016 Accepted: 10 June 2016 *Correspondence: Dr. Meena N. Satia, E-mail: meenasatia@kem.edu Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Although rare in modern obstetrics, emergency peripartum hysterectomy (EPH) remains a life-saving procedure, in the event of uncontrollable postpartum hemorrhage. Observations regarding the causes and outcomes of EPH provide valuable insights relevant to the current management perspectives in obstetrics. This study is intended to assess the contemporary prevalence, indications, and outcomes of EPH, at a Tertiary care referral institute. Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 3 years January 2011-December 2013, in the department of obstetrics and gynecology, at the KEM hospital, in Mumbai. Cases of EPH were analyzed for information, maternal age, parity, gestational age, type of delivery, indications for EPH and outcomes of the procedure. Results: The average annual incidence rate was1 per 1000 deliveries. 44% of the cases had an indication of abnormal placentation. 60% of the cases had caesarean section deliveries. Multiparity, previous LSCS, and gestation period of <37 weeks, were the commonly observed associations. 52% of cases required ICU admission. Maternal mortality rate was 8%. 20% of the cases had intrauterine fetal death. Conclusions: Abnormal placentation was evident as the leading cause of uncontrollable hemorrhage. This is possibly in view of a continual improvement in the management of uterine atony, reduced incidence of uterine rupture, and importantly, a rising trend of caesarean section delivery. This calls for more thoughtful considerations, regarding decisions for caesarean section delivery, in obstetrics practice. Keywords: EPH, Caesarean, Multiparity DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162123