Emergency Peripartum Hysterectomy at Sultan Qaboos University Hospital in Oman. Nine years’ study

Objective: To study risk factors, incidence, indications, maternal and perinatal complications of women who underwent emergency peripartum hysterectomy (EPH) at Sultan Qaboos University Hospital (SQUH) in Oman.
Method: This is a retrospective study, in which all cases EPH performed at SQUH between January 2007 and December 2016 were reviewed.
Results: During the 9 years study period, there were 18 cases of EPH; the total number of deliveries during the same period was 32,963, so the incidence of EPH was 0.55 per 1,000 deliveries. Of all cases of EPH, 13 cases (72.2%) were cesarean hysterectomy compared with 5 cases (27.8%) were postpartum hysterectomy. Twelve cases (66.7%) were total hysterectomy while 6 cases (33.3%) were subtotal hysterectomy. The most common risk factor for EPH was placenta previa and accrete with previous cesarean section (CS) (27.6%); followed by previous CS without placenta previa (24.1%). The most common indication for EPH was placenta previa and accreta (44.4%), and previous CS (16.7%). During the study period, there was only one case of maternal death (5.6%). There were no cases of stillbirths or early neonatal deaths. There were 4 cases of bladder injury (22.2%). Women aged between 35-34 years and para > 5 had the highest incidence of EPH (50.0%).
Conclusion: To reduce the incidence of EPH and its catastrophic consequences, we need to identify high-risk cases ante-natally and potential cases for EPH should be booked early during pregnancy and managed during pregnancy and delivery at a tertiary hospital by an experienced team.