Obstetric haemorrhage complicates 27% of maternal mortality in India, many cases are preventable by universal Active management of labour and optimal pregnancy and labour care. Peripartum Hysterectomy is a live saving surgery performed when conservative medical and surgical modality of treatment failes. The present retrospective study was conducted at HIMS, Hassan, Karnataka by analysis of data collected from case records of women delivering at the hospital from financial years 2018 to 2020, to study the prevalence and clinical profile of peripartum hysterectomy in the tertiary care centre over a period of 3 years.
Observation: Out of total deliveries of 23,249 during the study period, 12985(55.9%) were normal vaginal delivery, 10264(44.1%) were caesarean delivery, 30(0.13%) women underwent peripartum hysterectomy for uncontrolled PPH. All the women in the study group were of age <30years, 23% were primi gravida, 53% were second gravid, and 23% were multigravida. 60% women had undergone LSCS in previous delivery, 23% had predisposing factors pre-eclampsia and severe anaemia, indication for peripartum hysterectomy were Atonic PPH-60%, Adherent placenta-34%, traumatic PPH-3% and sepsis-3%,Average blood loss was 2500 ml, average packed blood product replacement rate was RBC 5.34± 2.8 units, FFP -4 ± 3.34, platelet infusion 4±2.38. Post-operative morbidity observed were- fever-5, ARDS-1, DIC-2, ARF-2, TRALI-1, UTI-3, intraoperative bladder injury-1, wound dehiscence-4, and spontaneous bowel perforation-1 and maternal death in referred cases-6.6% due to Atonic PPH.
Conclusion: Atonic PPH and placental complications are preventable indications for peripartum hysterectomy which may be reduced by prevention of risk factors, reduction of primary caesarean delivery and prenatal risk assessment for adherent placenta. Elective caesarean delivery may reduce the maternal morbidity and mortality. A change in universal practice of active management of labour at low resource settings with oxytocin injection by use of an alternative, effective, thermo stable oxytocic may reduce incidence of atonic PPH and related maternal morbidity and mortality.