Puerperal hysterectomy. Experience at a private institution

Abstract

Objectives: To determine the experience with puerperal hysterectomy in a private institution. Design: Retrospective, series of cases study. Setting: Clinica Santa Isabel, Lima, Peru. Participants: Women in the immediate post partum. Interventions: Between January 1 2000 and December 31 2011, from 15 201 births attended sixteen 29-42 year-old patients with puerperal hysterectomy (1.04 per thousand births) were studied. Main outcome measures: Frequency, indications and complications of puerperal hysterectomy. Results: History of uterine instrumentation either cesarean section or dilatation and curettage was present in 75%, and the procedure was performed in 12 cases during the cesarean section, three in the post partum and one following dilatation and curettage for 24 weeks immature delivery. It was an emergency in 68.8% and in a similar percentage total hysterectomy was performed. Most frequent indications were placenta accreta in six patients, uterine atony in five and uterine leiomiomatosis in other five (elective interventions). Surgical time was 65-170 minutes, media 105 minutes; blood transfusions were indicated in 9 patients (56.3%). No urinary tract or intestinal tract lesions were reported, and there was no maternal death. Conclusions: Puerperal hysterectomy was an apparently safe procedure at our institution, and frequency, indications and complications were similar to literature reports. Keywords: Puerperal hysterectomy, placenta accreta, uterine atony.