Emergency peripartum hysterectomies at Muhimbili National Hospital, Tanzania: a review of cases from 2003 to 2007.

A retrospective review of all cases of emergency peripartum hysterectomy performed between January 1, 2003 and December 31, 2007 at Muhimbili National Hospital was done to determine the incidence, indications and complications, background characteristics, antenatal care attendance, referral status, and maternal and foetal outcomes. There were 55,152 deliveries during the study period and 165 cases of emergency peripartum hysterectomy, giving the incidence of emergency peripartum hysterectomy of 3 per 1000 deliveries. The main indication was uterine rupture (79%) followed by severe post-partum haemorrhage due to uterine atony (12.7%). The case fatality rate was 10.3% where as perinatal mortality rate was 7.7 per 1000 deliveries. The common complication identified intraoperatively was severe haemorrhage which accounted for 39.4% where as intensive care unit admissions (14.4%) and febrile morbidity (12.4%) were common after the operation. Blood was ordered in all cases but in 31 cases it was indicated that it was not available. Seventy nine patients received blood transfusion with the maximum number of units given to one patient being eight. Twenty two patients were given fresh frozen plasma (FFP), the median number of units given was two (range = 1-6). In conclusion, emergency peripartum hysterectomy is a life saving procedure and very common at MNH. The most common indication was ruptured uterus followed by severe postpartum haemorrhage. More than half of the patients underwent emergency peripartum hysterectomy were referred from other health facilities with ruptured or suspected ruptured uterus. The procedure was associated with unacceptably high maternal and perinatal morbidity and mortality.