Peripartum hysterectomy: Two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa

JN Wandabwa, C Businge, B Longo-Mbenza, ML Mdaka, P Kiondo

Abstract

Background: Obstetric haemorrhage is the leading direct cause of maternal mortality in South Africa.
Objective: To determine the incidence, indications, associations and maternal outcomes of emergency peripartum hysterectomies.

Methods: A descriptive and retrospective analysis of patients who had peripartum hysterectomy between 1st February 2007 and 31st January 2009 in Nelson Mandela Academic Hospital at Mthatha city.

Results: The incidence of 0.95% of peripartum hysterectomies (n=63 or 9.5/1000 births) increased with the increasing maternal age from 0.121% at age of less than 20 years to 0.5% at age more or equal to 30 years. Similarly the incidence increased with parity from 0.332% for Primiparity to 0.468% at parity of four or more. The indications for the operation were uterine atony 19/63 (30.2%), secondary haemorrhage/puerperal sepsis 17/63 (27%) and ruptured uterus 16/63 (23.4%). The main intra operative complication was haemorrhage 13/63 (20.6%). Repeat laparotomy was done in 10/63 (15%) of patients due to haemorrhage. Admission to intensive care unit was 25/63 (39.7%). The case specific mortality ratewas of 19 % (n=12). The main causes of death were hypovolaemic shock and septicemia.

Conclusion: The incidence of peripartum hysterectomies was high and was associated with ruptured uterus and puerperal sepsis which are  preventable.

Key Words: Peripartum, Hysterectomy, Uterine atony, Ruptured uterus, secondary haemorrhage.