Peripartum hysterectomy audit at Port Shepstone Regional Hospital, South Africa : a five year review.

Abstract

Background Over the years the peripartum hysterectomy has become a life-saving procedure in cases of intractable postpartum haemorrhage or when medical and/or surgical conservative interventions have failed and in severe puerperal sepsis. Aim To audit the clinical management preceding peripartum hysterectomy and evaluate maternal and neonatal outcomes in patients who were done peripartum hysterectomy. Material and Methods The researcher developed a structured audit form based on specific types of pregnancy and delivery complications leading to peripartum hysterectomy. The medical records of 126 patients who had postpartum hemorrhage and 83 patients who had undergone peripartum hysterectomy from 1st January, 2010 to 31st December, 2014 (5 years), at Port Shepstone Hospital in Kwa-Zulu Natal were reviewed retrospectively. Maternal characteristics and details of the present pregnancy and delivery, hysterectomy indications, complications, postoperative complications, and maternal and neonatal outcomes were evaluated. A statistical package (SPSS version 24.0) was used to analyze the data. Results During the 5-year study period, a total of 17657 births occurred. There were 83 peripartum hysterectomy cases and 126 postpartum hemorrhage cases. The incidence for peripartum hysterectomy was 0.47% (4.7/1000 deliveries) and incidence for postpartum hemorrhage was 0.71% (7.1/1000 deliveries). In patients with PPH, post C/S peripartum hysterectomy incidence was 7.2/1000 C/S deliveries and post vaginal peripartum hysterectomy incidence was 0.65/1000 normal vaginal deliveries. There was a statistical significant relationship between peripartum hysterectomy and cesarean section delivery in the current pregnancy and previous cesarean delivery (p=0.0001 and p=0.01 respectively). Sixty two (49.2%) of 126 postpartum hemorrhage cases were unresponsive to conservative medical and surgical measures and required peripartum hysterectomy. Five patients with uterine rupture did not have any conservative management and proceeded to peripartum hysterectomy. Sixteen (19.3%) patients with sepsis were sent directly for peripartum hysterectomy.