Emergency peripartum hysterectomy in a Nigerian hospital: a 20-year review.

Postpartum haemorrhage is a major cause of maternal morbidity and mortality and occasionally severe enough to warrant hysterectomy to prevent maternal death. Hysterectomy often is fraught with danger and regular audit is necessary to assist in the reduction of these dangers. A 20-year audit of all emergency peripartum hysterectomies, performed at Havana Specialist hospital Lagos, Nigeria, is reported. Of the 6599 deliveries and peripartum referrals seen during the period, 22 had an emergency hysterectomy as a result of severe postpartum haemorrhage (0.33%). The aetiological factors associated with the postpartum haemorrhage included uterine atony (45.5%), placenta praevia (27.3%), pathologically adherent placenta (18.2%) and ruptured uterus (9.1%). The majority of the procedures were subtotal hysterectomy (81.8%) and the mean operative time was significantly shorter than for total hysterectomy (P<0.05). The postoperative complications included postoperative anaemia (28.6%), febrile morbidity (36.9%), wound infection (19.0%) and urinary tract infection (9.5%), together with three maternal deaths. In conclusion, emergency peripartum hysterectomy, although life-saving, is associated with severe morbidity and mortality and subtotal hysterectomy is usually the operation of choice.