Peripartum hysterectomy in RIPAS Hospital: Experience over an 11-year period.



Department of Obstetrics and Gynaecology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam



Introduction: Peripartum hysterectomy refers to hysterectomy that is performed for complications of vaginal delivery or during caesarean section. A common reason for peripartum hysterectomy is post partum haemorrhage (PPH). The aim of this study is to assess the incidence, indications and risk factors for emergency peripartum hysterectomy carried out at RIPAS hospital over an 11-year period. Materials and Methods: Patients who had undergone emergency peripartum hysterectomy over this 11-year (1999-2009) period were identified from the operation registry and the medical records were retrospectively reviewed. Data on maternal age, parity, gestational age, indication for peripartum hysterectomy, the type of operation performed and estimated blood loss were collected. Results: During the study period, there were a total of 59,974 deliveries (83.8% vaginal deliveries and 16.2% caesarean section deliveries) and 6,530 emergency obstetric surgeries. There were a total of 33 emergency peripartum hysterectomies performed accounting for 0.5% of all emergency obstetric surgeries performed. This translated to an overall incidence rate of 5.5 peripartum hysterectomies per 10,000 deliveries: 1.2 per 10,000 vaginal deliveries (n=6) and 27.9 per 10,000 caesarean sections deliveries (n=27). All peripartum hysterectomies were performed for massive PPH. The most common underlying pathology was placenta praevia (57.57%) followed by uterine atony. The risk for peripartum hysterectomy was high if placenta praevia was associated with previous scarred uterus as there is more chance of accreta. Conclusion: Our peripartum hysterectomy rate is comparable to what has been reported in the literature. The rate was higher for caesarean section deliveries. All peripartum hysterectomies were performed for PPH.



Keywords: Emergency hysterectomy, placenta previa, postpartum haemorrhage, peripartum complications, uterine atony


Correspondence author: Anayath INDULEKHA, Department of Obstetrics and Gynaecology, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam

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Brunei Int Med J. 2012; 8 (3): 122-127