Adesiyun Adebiyi Gbadebo, Eseiegbe Edwin, Ameh Charles Anawo.
Inevitable peripartum hysterectomy in a tropical hospital: indications and maternofetal outcome.
Pak J Med Sci Jan ;24(1):122-6.

Objectives: To determine the indications for inevitable peripartum hysterectomy (IPH), associated demographic variables and the materno fetal outcome. Methodology: A retrospective analysis of twenty two patients that had inevitable peripartum hysterectomy (IPH) during the study period of 4 years, July 2001 to June 2005. Results: The mean age of the patients was 32.4 years with a range of 18 to 47 years. The parity ranged from 1 to 9. The parity distribution was positively skewed indicating the rate of IPH increased with parity. Sixteen (72.7%) patients did not have antenatal care and 21(%) out of the 22 patients were refereed from other health facilities. Indications for IPH were ruptured uterus in 16(72.7%) patients, uterine atony in 4(18.2%) patients. Of the 22 patients, 15 (68.2%) delivered per abdomen while 7(31.8%) delivered per vagina. The indications for abdominal delivery were laparotomy for ruptured uterus with extraction of the fetus in 11 (50%) patients and caesarean section in 4(18.2%) patients on account of placenta praevia in 2 patients. Of the 7 patients that delivered per vaginam, 3(13.6%) had spontaneous vertex delivery, 1(4.5%) had vacuum delivery, 2(9.1%) had breech extraction of second twin and 1(4.5%) patient had embryotomy. Subtotal hysterectomy was the most commonly preformed type of hysterectomy in 17(77.5%) of the cases. High maternal mortality of 59.1% and perinatal mortality of 77.3% was recorded in the study. Conclusion: Ruptured uterus which is associated with poor pre-surgical clinical state was the leading indication for IPH in this study. This may be responsible for the high maternal and fetal mortality recorded in this study and not necessarily the hysterectomy procedure itself.

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