Profiles and outcomes of women undergoing hysterectomy for primary postpartum haemorrhage at Chris Hani Baragwanath Hospital
Date
2013-05-14
Authors
Hassim, Taheera
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Objective
The study aimed to identify the profiles and outcomes of women undergoing
hysterectomy for primary postpartum haemorrhage (PPH).
Methods
This was a retrospective descriptive study of maternal records of all women that
underwent hysterectomy for primary postpartum haemorrhage (PPH) from January 2008
to December 2008.
Results
Twenty-seven women underwent hysterectomies for primary postpartum haemorrhage
(PPH). Eighty nine percent of the women were booked, with a mean of 4.8 antenatal
visits. Previous caesarean section and retained placenta were the main risk factors
associated with hysterectomy for PPH, with retained placentae being the principle
etiological factor (37% of cases). Forty percent of patients had one or more previous
caesarean section. Atony was the leading cause of emergency hysterectomy (63%).
Subtotal hysterectomy appeared to be the procedure of choice (70% of cases).
Conservative management was not attempted in most cases. After hysterectomy, 18(29%)
of women were admitted to the multidisciplinary intensive care unit. Two women died
(7%).
Conclusion
Postpartum haemorrhage requiring hysterectomy appears to be an unpredictable
emergency with no specific risk profile for peripartum hysterectomy. Conservative
management could have been attempted more frequently. The findings have implications
for peripheral hospitals that manage obstetric patients who have no specific risk factors
for PPH. The possibility of emergency hysterectomies exists for all births and health
workers need to be able to recognize and manage this emergency appropriately.
Peripartum hysterectomy (PH) may be a lifesaving procedure and every obstetric doctor
needs to be proficient in performing a subtotal hysterectomy at the very least.
Description
Thesis (M.Med.(Obstetrics and Gynaecology)--University of the Witwatersrand, Faculty of Health Sciences, 2012