Peripartum hysterectomy: prevalence, indications, maternal outcomes, and associated factors in a 7-year retrospective review at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia

Abstract

BACKGROUND: Peripartum hysterectomy (PH) is a life-saving surgical procedure for severe childbirth complications such as uncontrollable bleeding, uterine rupture, or severe infection. Despite its crucial role in obstetric care, research on the prevalence of PH and the factors contributing to its necessity remains limited, necessitating further evaluation. OBJECTIVE: To evaluate the the prevalence, indications, and maternal outcomes of PH and identifying factors associated with maternal outcomes among women who underwent PH at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia. METHODS: A retrospective cross-sectional study was conducted on 162 participants using data from March 2017 to April 2023. Data were extracted from patient records between February and April 2023 and analyzed using SPSS version 26. Descriptive statistics were reported, and variables with p < 0.25 in bivariate analysis were included in the multivariable model, with statistical significance set at p ≤ 0.05. RESULTS: A review of 162 maternal charts involving PH showed a rate of 5.2 per 1,000 deliveries. Most hysterectomies (87%) were performed following cesarean delivery. The primary indications for PH included uterine rupture (75.3%), uterine atony (17.3%), placenta accreta (4.9%), and deep surgical site infection (1.9%). Severe maternal morbidity included wound infections (24.7%), adjacent structure injuries (8.6%), re-laparotomies (7.4%), and other complications (6.8%). Intensive care unit admission occurred in 37%, and 83.3% required blood transfusions. Maternal and perinatal mortality rates were 23.5% and 75.9%, respectively. The key predictors of maternal outcome included delivery in the study hospital, pre-operative blood pressure of < 90/60 mmHg, and pre-operative blood transfusion. CONCLUSION: PH is a major contributor to maternal morbidity and mortality, primarily due to uterine rupture. The relatively high PH rate suggests significant maternal health challenges. To address this, improvements in preoperative care, early detection of complications, and enhanced emergency obstetric services could help reduce the need for hysterectomy and improve maternal and perinatal outcomes.