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PL.62 Peri-Partum Hysterectomy: Still Required For Management of Post-Partum Haemorrhage?
  1. SM Barr,
  2. V Leburn,
  3. J Richmond
  1. NHS Greater Glasgow & Clyde, Glasgow, UK

Abstract

Background Postpartum haemorrhage (PPH) complicates 5–10% of all deliveries in the UK. While the use of uterotonic agents and compression devices has reduced the requirement for definitive surgical intervention, examination under anaesthetic, exploratory laparotomy and peri-partum hysterectomy remain in use to control intractable haemorrhage.

Method Cases of obstetric examination under anaesthetic (n = 66), exploratory laparotomy (n = 13) and peri-partum hysterectomy (n = 10) carried out in the Southern General Hospital were identified from theatre logs and the clinical risk reporting system from April 2009 to November 2012. Clinical features including estimated blood loss and interventional radiology involvement were extracted. Total births for this period was 16050.

Findings The incidence of return to theatre for the management of PPH was 0.41% of total deliveries over this period. Of these cases, exploratory laparotomy was performed in 20% (n = 13); peri-partum hysterectomy was required in 10.5% (n = 7) of those cases, with an overall incidence of 0.06%. A further three cases of caesarean hysterectomy were also identified; these were elective procedures for antenatally diagnosed invasive placentation. Where hysterectomy was performed, the underlying pathologies were uterine atony (n = 6) and invasive placentation (accreta and percreta, n = 4).

Conclusion Surgical intervention for management of severe post-partum haemorrhage is rarefor the overall obstetric population but remains necessary for management of uterine atony unresponsive to pharmacological management or compression and in cases of invasive placentation. Obstetric training should reflect this accordingly.

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