International Journal of Clinical Obstetrics and Gynaecology

Author(s): Montacer Hafsi, Houssem Ragmoun, Youssef Nouaili, Eya Kristou, Amina Abaab, Meriem Bezzine and Arina Jbari

Abstract: Background: Peripartum hysterectomy is a life-saving intervention for severe postpartum hemorrhage (PPH) unresponsive to conservative management, but it carries significant maternal morbidity. Understanding its indications and outcomes in resource-limited settings is critical. Objective: To evaluate the epidemiology, risk factors, indications, complications, and factors influencing the choice between total and subtotal hysterectomy in 40 women undergoing peripartum hysterectomy for PPH at a secondary maternity hospital. Methods: A retrospective, single-center study was conducted at Manzel Temim Regional Hospital (level IIA maternity) from January 2018 to January 2021. Women delivering after 28 weeks’ gestation with PPH requiring hysterectomy were included. Data on demographics, obstetric history, PPH management, and outcomes were extracted from medical records. Descriptive statistics summarized characteristics, and logistic regression identified factors associated with hysterectomy type (total vs. subtotal). Results: Among 6,021 deliveries, 40 hysterectomies were performed (incidence: 6.64 per 1,000). Mean maternal age was 30.3±6.8 years. Cesarean delivery (80%), scarred uterus (75%), and multiparity (57.5%) were prevalent risk factors. Placenta accreta (45%) and uterine atony (37.5%) were the leading indications. Hysterectomy was performed immediately in 52.5% of cases and after failed conservative measures in 47.5%. Subtotal hysterectomy was more common (65%) than total (35%). Multivariate analysis identified placenta accreta (aOR: 9.9, 95% CI: 2.3-42.7, p=0.002), blood loss volume (p=0.025), intraoperative hemoglobin (p=0.001), and transfusion requirements (p=0.007) as predictors of total hysterectomy. Complications occurred in 35% of cases, with no maternal deaths. Conclusion: Peripartum hysterectomy at a secondary maternity hospital effectively managed severe PPH, with placenta accreta driving total hysterectomies and atony favoring subtotal. Enhanced prenatal care and conservative management access could reduce hysterectomy rates.

DOI: https://doi.org/10.33545/gynae.2025.v9.i2c.1615

Pages: 180-183 | 153 Views | 58 Downloads

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