Peripartum Hysterectomy: Comparison of the Outcome of Caesarean and Postpartum Hysterectomy

Abstract

Objective: To compare the risk factors and complications of Caesarean hysterectomy (CH) and postpartum hysterectomy (PH) in a single obstetric unit over the last 15 years.
Methods: A retrospective review was made of 48 cases of peripartum hysterectomy performed from 1999 to 2014 (15 years). Cases were classified as CH or PH group. Epidemiological data, indications for hysterectomy, total blood loss, complications, and re-laparotomy rate were analysed and compared between the two groups.
Results: The Caesarean section rate was 20.2% among the 68,211 deliveries during the study period. The incidence of hysterectomy following Caesarean deliveries was 0.25% (n=35), that following vaginal delivery was 0.023% (n=13). The most common indication for CH was placenta praevia, that for PH was uterine atony. Total blood loss was comparable between the two groups but a significantly higher proportion in the PH group had disseminated intravascular coagulopathy (DIC) [85% vs. 49%] and required more units of blood transfusion compared with the CH group. Within the entire cohort, eight (17%) cases required re-laparotomy due to re-bleeding, and these cases had a significant higher risk of postoperative complications, longer length of intensive care unit stay, and need for ventilatory support.
Conclusion: Uterine atony and placenta praevia were the most common indications for peripartum hysterectomy. There were no major significant differences in the clinical outcome between CH and PH patients, but the incidence of DIC was apparently higher in the PH group compared with the CH group.