Peripartum hysterectomy for primary postpartum haemorrhage: incidence and maternal morbidity.

This was a retrospective analysis of postpartum emergency hysterectomy performed between 1988-2003, to study incidence indicators, risk factors and complications. We included any women who required emergency hysterectomy to control major postpartum haemorrhage (PPH) after delivery, following a pregnancy of at least 24 weeks' gestation, regardless of the mode of delivery. We excluded cases that required a hysterectomy for gynaecological reasons. There were 18 cases of emergency hysterectomy (14 caesarean hysterectomy and four postpartum hysterectomy, after vaginal delivery), giving a rate of 0.36/1,000 deliveries. Overall, the most common indication for hysterectomy was placenta accreta (28%) and uterine atony (28%). Although there was no maternal death, intra- and postoperative complications were prevalent including cardiac arrest (1), disseminated intravascular coagulopathy (4), pulmonary oedema (1), septicaemia (1), and bladder injury (1). Placenta accreta is becoming a leading cause of emergency postpartum hysterectomy. Although hysterectomy is a life saving operation, it is associated with high maternal morbidity.