Background Peripartum Hysterectomy (PH) is a rare complication of pregnancy¹. This study sought to determine the rate of PH in our population and compare aetiology and clinical outcomes in cases of PH that are anticipated and unanticipated.

Method Cases of PH for obstetric haemorrhage between 2006 and 2011 were identified from an MOH database. Data included maternal demographics, subspecialty of operator, aetiology for PH, estimated blood loss(EBL), RCC units transfused, surgical complications and length of hospital stay.

Results 26 cases of PH (0.6/1000) were identified; 17 anticipated and 9 unanticipated. Placenta accreta (PA) was the indication for PH in 15/17 anticipated and 4/9 unanticipated cases. The remaining cases were attributed to uterine rupture (3/9), placenta previa, cervical ectopic and atony.

Discussion The majority of cases of PH are anticipated because of prenatal diagnosis of placenta accreta and are more likely to undergo elective delivery by a gynae-oncologist. Despite this EBL, RCC transfusion and postoperative complications are not significantly different from unanticipated cases of PH, possibly reflecting the severity of cases diagnosed antenatally. Continuing research is required to improve the prenatal diagnosis of placenta accreta and to reduce perioperative blood loss with measures such as interventional radiology².

References

1. Flood et al. Changing trends in peripartum hysterectomy over the last four decades. Am J Obstet Gynecol 2009 Jun; 200(6):632.e1–6.

2. Angstmann et al. Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol 2010 Jan; 202(1):38.e1–9. Epub 2009 Nov 17.