An audit of the indications for peripartum hysterectomies performed at a tertiary institution in Johannesburg, South Africa: a retrospective study

Abstract

Background: Peripartum hysterectomy (PH), the surgical removal of the uterus during or shortly after childbirth, is a critical procedure in maternal healthcare. Definitions of PH vary globally leading to challenges in understanding its occurrence. Our study aimed to provide comprehensive insights into PH in a South African context, investigating indications, demographic characteristics, clinical and histopathological diagnoses, complications, and outcomes. Methods: A retrospective record review study design was used, focusing on PH cases at a tertiary facility in Johannesburg, SA. The study period was between January 2018 and December 2020. Medical records were systematically examined to identify trends, indications, and outcomes associated with PH. Data collection encompassed demographic characteristics, obstetric history, clinical indications, clinical and histopathological diagnoses, and complications. Data analysis used descriptive statistics, interrater reliability tests and comparative findings with previous SA studies. Results: The study included 56 peripartum women who underwent PH. Pregnancy-related sepsis emerged as the most common indication, with an 88.8% (16/18) histopathological confirmation rate. Abnormal placentation and uterine rupture were also common indications. Clinical and histopathological diagnoses exhibited a strong level of agreement (70.9%), emphasising the importance of accurate diagnostics. We found an evolving landscape of PH indications in South African clinical setting, with pregnancy related sepsis surpassing historical indications. We found a prevalence of maternal deaths amounting to 21.4% (12/56). Conclusion: Our study found a shift in the primary historical indications such as uterine atony and uterine rupture in South Africa, with pregnancy-related sepsis emerging as the primary v indication in recent years. Clinical assessment complemented by histopathological findings remains critical for improved obstetric complication management.