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OBJECTIVE: We aimed to identify the risk factors and subsequent maternal and perinatal outcome associated with the procedure of peripartum hysterectomy. MATERIALS AND METHODS: This was a retrospective case review carried out at the Professorial unit, North Colombo Teaching Hospital, Ragama, of all patients who underwent a peripartum hysterectomy from January 2000 to December 2004. RESULTS: Eighteen cases were performed during the study period from a total of 28,038 deliveries (0.064%) mean maternal age was 33 years (24-43), There were five nulliparous patients. Seven patients had previous vaginal deliveries. Six had a history of previous caesarean section, four of whom had more than one caesarean sections. The indications for the hysterectomy were placenta praevia (2), abruptio placenta (1), atonic postpartum haemorrhage (7), placenta accreta (3), traumatic postpartum haemorrhage (5). All
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patients received blood transfusions, 27% receiving more than 10 units. There were five maternal deaths (Maternal mortality rate 17.8 /100,000). There were two stillbirths and one neonatal death secondary to antepartum haemorrhage. CONCLUSION: Even though the maternal mortality was not very high, the associated maternal morbidity and perinatal mortality were high. One third of the cases were associated with previous caesarean section. The caesarean section rate is increasing worldwide for many reasons, including recent emphasis on maternal request. We recommend that caesarean section be performed only for valid clinical indications which should help reduce the problems associated with peripartum hysterectomy. |
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