The Incidence and Risk Factors of Peripartum Hysterectomy at the Georgetown Public Hospital Corporation (GPHC)

Aim: To assess the incidence and risk factors of peripartum hysterectomy at the Georgetown Public Hospital Corporation over a period of five years.

Background: A hysterectomy carried out at the time of delivery or within 24 hours of it is referred to as a "peripartum hysterectomy" (WHO). Postpartum hemorrhage (PPH) is a potentially fatal condition that needs to be treated right away. Over time, numerous medications and surgical procedures have been created, particularly to protect the uterus. However, as a last resort to save a woman's life, an emergency peripartum hysterectomy must occasionally be carried out1. Uterine atony, abnormal placental implantation (accreta, previa, etc.), uteroplacental apoplexy, uterine rupture due to cicatricial uterus, advanced maternal age, increased parity, birth weight less than 4,000 g, and prior uterine surgery are the most significant risk factors that result in Emergency Peripartum Hysterectomy (EPH).

Objectives: This study sought to identify the risk factors and indications for peripartum hysterectomy at GPHC, as well as to analyze the complications and outcomes of peripartum hysterectomy performed in GPHC from January 2016 to January 2020. It also sought to provide insight into the incidence of peripartum hysterectomy after medical and surgical management for the management of bleeding during or after delivery was exhausted.

Methods: Retrospective chart reviews of patients who underwent peripartum hysterectomy in Georgetown Public Hospital Corporation's Department of Obstetrics and Gynecology over a five-year period from January 2016 to January 2020 were the goal of this study. The medical record department was contacted to obtain the medical history of every woman who had a peripartum hysterectomy. Risk factors, intrapartum and peripartum notes, operative notes and findings, complications, surgery time, blood loss, and outcomes were all carefully examined in each case file.

Results: A total of 6,130 caesarean deliveries were recorded in GPHC during the study period. There were 26 peripartum hysterectomies performed in total during the study period, making the incidence of this procedure 4.2 per 1,000 births. Maternal age greater than 30, prior caesarean deliveries, and multiparity were the main risk factors for peripartum hysterectomies. Early pregnancy loss with prolonged bleeding (31%) and abnormal placentation (which accounted for 27% of patients who underwent peripartum hysterectomy) were noted as the main indications for the procedure.

Conclusion: According to the data, abnormal adherent placentation is what leads to peripartum hysterectomy most frequently. The data also show how the likelihood of needing an emergency peripartum hysterectomy increases significantly with parity, particularly when multiparity, a placenta previa, or a previous cesarean section, are factors. Despite the continued high levels of maternal morbidity, no maternal deaths occurred.