PERIPARTUM HYSTERECTOMY: A LIMITING FACTOR FOR PROCREATIVE POTENTIAL & SAFE-MOTHERHOOD: A 5 YEARS RETROSPECTIVE STUDY

BACKGROUND: The term hysterectomy means surgical removal of uterus it can be either along with cervix or adnexae through different routes. The most commonly performed major elective gynecological surgery. The term Peripartum hysterectomy is used when performed either mostly by emergency as a maternal life saving measure within 24 hours after vaginal or abdominal delivery or as electively when indicated. OBJECTIVE: To study the incidence of peripartum hysterectomy; to analyze its causes, risk factors, complications and feto-maternal morbidity and mortality at newly established tertiary care teaching hospital. PLACE OF STUDY: Rajiv Gandhi Institute of Medical Sciences (RIMS), Kadapa, YSR district, Andhra Pradesh, South India. DESIGN AND DURATION: Retrospective study of 5 years period, Jan.'2010 to Dec.'2014. MATERIALS AND METHODS: 42 cases of peripartum hysterectomised patients medical records reviewed for characteristics of current pregnancy and delivery, indications for peripartum hysterectomy, operative and post-operative complications, maternal and perinatal outcome evaluated. RESULTS: 42 cases of peripartum hysterectomy identified out of 32398 total deliveries (1.3 in 1000). Among them 23 cases was Laparotomy for rupture uterus, Caesarean hysterectomy in 12 cases, followed by vaginal delivery in 6 cases and for chronic ectopic pregnancy with bilateral T.O. mass in 1 case (P2 L2 + Bil. T. with chronic ectopic for failed tubectomy). No Live Children in 9 cases & 1 Live Child in 19 cases were identified and 2 or more Live Children in 14 cases. CONCLUSIONS: The incidence of peripartum hysterectomy is similar to the data found in studies of other Asian countries. Most frequent indication being rupture uterus leading to high perinatal, maternal mortality and morbidity limiting the child bearing capacity (Procreative Potential). To reduce this high incidence of peripartum hysterectomy effective MCH services to be exercised at all the levels of health care delivery system in developing countries like India to maintain safe-motherhood.