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Background: Hysterectomy in the peripartum period is a life-saving emergency procedure that is associated with both intra-operative and post-operative morbidities. This study aims to determine the prevalence of emergency obstetric hysterectomy (EOH), the indications, and the pattern of post-emergency obstetric hysterectomy complications and their outcome in our setting. Methodology: This was a retrospective study of parturients that had an emergency obstetric hysterectomy (EOH) over a five (5)-year period from 1st January 2008 - 31st December 2012. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, and complications of the procedure were extracted. The data obtained were analysed using the statistical product and service solutions (SPSS) 15.0. Results: There were 16,720 deliveries during the five-year period of the study. Emergency obstetric hysterectomies were performed in sixty-nine patients giving a prevalence of 0.4% or 1:242 (4.1 per 1,000) deliveries. Uterine rupture, 33(47.8%) was the leading indication, while the subtotal hysterectomy was the commonest surgery performed 42 (60.9%). The commonest post-hysterectomy morbidities were anaemia, 60 (86.9%) and wound sepsis, 16 (23.2%). Maternal mortality occurred in 7 patients giving a case fatality rate of 10.1%. Conclusions: The prevalence of EOH in this study was high with uterine rupture as the leading indication. Wound sepsis and anaemia were the most common post-EOH complications and the case fatality rate was high. Measures must be put in place to prevent uterine rupture and obstetric haemorrhage in our setting.
RESUMEN
AIM: This study aimed to determine the prevalence of episiotomy and postepisiotomy complications and to assess the relationship between the risk factors and postepisiotomy complications in the University of Port Harcourt Teaching Hospital. METHODOLOGY: This was a descriptive longitudinal study, in which 403 consecutive women who had episiotomy in the labor ward were recruited for the study. They were followed up and reviewed at the postnatal clinic on the 1st and 6th weeks postdelivery. Data regarding age, marital status, occupation, educational status, address, parity, booking status, postepisiotomy complications, and the associated risk factors were entered adequately into a prestructured pro forma, and statistical analysis was done using statistical software (SPSS for Windows® version 19.0). t-test was used to explore the association of risk factors to postepisiotomy complications. RESULTS: The episiotomy rate was 22.1%. The prevalence of postepisiotomy complications was 52.1%. The mean age of the women was 23.8 (standard deviation ± 3.2) years. Seventy-two (34.3%) patients had perineal pain, which lasted for 72 h or more; 61 (29.1%) had difficulty in walking, while 37 (17.6%) had perineal discomfort. Four (1.9%) had wound infection and only one (0.4%) had wound dehiscence. The development of postepisiotomy complications was not statistically significantly associated with risk factors such as gestational age (T = 1.4, P = 0.1), packed cell volume on admission (T = 1.0, P = 0.2), duration of first stage of labor (T = 0.5, P = 0.1), duration of second stage of labor (T = 0.7, P = 0.3), duration of rupture of fetal membranes (T = 0.8, P = 0.4), delivery repair interval (T = 0.6, P = 0.2), estimated blood loss (T = 0.9, P = 0.2), duration of Sitz bath (T = 1.0, P = 0.2), duration of analgesic (T = 1.2, P = 0.1), duration of antibiotics (T = 1.3, P = 0.1), or the operator who performed or repaired the episiotomy (P = 0.2). CONCLUSION: The prevalence of episiotomy and postepisiotomy complications in this study was high. Necessary attention should be given to ensure adequate pain relief for all parturients who had episiotomy, and the policy of restrictive use of episiotomy should be fully implemented in the department in line with the best practices and evidence-based recommendations. This will further reduce the incidence of episiotomy rate as well complications that may arise from it and ensure a positive pregnancy experience for pregnant women.