Intisar Ali Mohammed1*, Nabil Ahmed Al-Rabeei2
1Department of Obstetrics and Gynecology Faculty of Medicine and Health Sciences, Sana’a University
2Nursing Division, Faculty of Medicine and Health Sciences, Sana’a University.
SUJMS • 2020 | Jan-Dec | Vol 14| Issue (1+2)
Peripartum hysterectomy has been described as catastrophic procedure and is often performed in acute life threating emergency1. The difficulty associated with the procedure is not necessarily the surgical technique but is the support of such ill patients. These difficulties are more pronounced in developing countries when institution are inadequately founded, facilities are lacking and patients are present in the hospital very late where pathology is advanced2.
The incidence of cesarean hysterectomy is 8.3 per 1000 cesarean3. Even today 8-10% of maternal mortality in developing countries directly occur due to massive obstetrical hemorrhage4. Maternal mortality in Yemen still unacceptably high, the majority of these deaths occur in poor illiterate women who make little use of modern obstetric care has therefore been proposed as a major necessity in the reduction of maternal mortality5.
The indication for peripartum hysterectomy includes uterine atony unresponsive to conservative measures, previous cesarean birth, laceration of major vessels, abnormal placentation, cervical dysplasia, or carcinoma in situ6,7.
Vaginal birth after cesarean, primary and repeat cesarean deliveries and multiple births are independently associated with an increased risk for peripartum hysterectomy7.The association between placenta previa accrete and prior cesarean sections was confirmed, and the incidence of the placenta accrete increased as the number of previous cesarean sections increased.
The patient with antepartum hemorrhage due to placenta previa, who had a previous cesarean section should be considered at high risk for developing placenta accrete3,8.
The combination of high parity, cesarean section, prior cesarean delivery, current placenta previa and oxytocin use for uterine stimulation were among the risk factors for uterine atony and should alert the obstetrician that an emergency peripartum hysterectomy may needed3,9. Risks of the cesarean hysterectomy include increased operative time, blood loss, increased rate of infection, and higher contaminated incidence of damage to bladder and ureters than in non-gravid hysterectomy or cesarean section alone10. In addition, the cervix is not easily identified in a labored uterus and may not be completely excised at the time of cesarean hysterectomy.