Abstract

Peripartum hysterectomy can be required to control persistent postpartum haemorrhage. This audit aimed to review the incidence, management and outcomes of women undergoing peripartum hysterectomy.

This was a retrospective audit of women undergoing peripartum hysterectomy at the Simpson Centre of Reproductive Health, Edinburgh, over an 8-year period from 2002 to 2010.

Peripartum hysterectomy was defined as hysterectomy performed following delivery of a fetus and categorised as primary or secondary. There were no maternal deaths and the rate of peripartum hysterectomy was 5.9 per 10 000 deliveries.

26 of the 28 patients delivered the index pregnancy by caesarean section. The most common reasons for obstetric haemorrhage were abnormal placental site and adherence and uterine atony.

All 16 placenta praevia were identified antenatally and ten required emergency caesarean section due to significant antepartum haemorrhage. Only 11 patients received documented counselling on the possibility of hysterectomy. These women all had a placental abnormality diagnosed antenatally.

Patients with documented uterine atony received at least two uterotonics. Uterotonics were given less frequently in patients with placental problems.

Fifty percent of patients suffered at least one post-operative complication.

Two patients received ICU care and all patients spent time in HDU. All patients received appropriate thromboprophylaxis. Fetal outcomes were good.

The rate of peripartum hysterectomy was slightly higher than the national average (4.1%) and included one secondary peripartum hysterectomy.

This audit highlights many important learning points. Counselling for women undergoing caesarean section with anticipated major obstetric haemorrhage should include the documented possibility of hysterectomy and post-operative complications.