Peripartum Hysterectomy: 5 Year Review of Prevalence, Trend, Risk Factors and Obstetric Outcomes in a Tertiary Centre in Southern Nigeria

Abstract

Peripartum hysterectomy is a life saving procedure performed during delivery or during the puerperium usually before discharge from delivery hospitalization. It is an indicator of near miss obstetrics and its obstetric outcomes can be used as an assessment of emergency obstetric care services. The aim of this study is a review of the risk factors, trends and obstetric outcomes of this procedure in a tertiary centre in Southern Nigeria. The study was a 5 year retrospective study carried out at the Rivers State University Teaching hospital, Port Harcourt between January 2019 and December 2023. Majority, 54.2% of the participants were aged between 30 and 39 years (mean age of 33.7 ± 5.5) with 41.7% being Para 2. The mean gestational age was 37.3 ±2.8 and 70.8% had their pregnancies booked. Of the total of 8,739 deliveries, 4,956 were by Caesarean Sections (56.7%). A total of 24 peripartum hysterectomies were performed giving an incidence rate of 2.75 per 1000 deliveries. Sub-total hysterectomy was commonly performed (87.5%). 62.5% of the participants had a history of a previous caesarean section while 83.3% had a caesarean section in the index pregnancy. The indication for the procedure was uterine rupture and uterine atony in 85.7% of cases while the rest were for abnormal placentation. There was no maternal death and the perinatal mortality was 29.2%. All the participants required blood transfusion.    The caesarean section rate of 56.7% in this study is high and is on the increase globally. Efforts to reduce the caesarean section rates is imperative as a history of caesarean section is a consistent risk factor for peripartum hysterectomy across various studies including this study. Obstetric haemorrhage from uterine rupture/atony requiring blood transfusion is the commonest indication and therefore the availability of blood transfusion services as an essential component of an emergency obstetric unit cannot be over-emphasized. The attendance of a senior obstetric staff improves outcomes.