PERIPARTUM HYSTERECTOMY.

Peripartum hysterectomy refers to the hysterectomy performed during delivery or within 24 hours. This is a relatively rare procedure, that can be emergent or planed depending on the indication. In about 30-50% cases of emergency performed hysterectomies the cause is represented by severe uterine hemorrhage, which is impossible to control by the usual methods, as it happens in abnormal placentation or uterine atony. Conservative methods should always be attempted in order to avoid if possible the morbidity and sterilization implied by hysterectomy. Regarding the risk factors for peripartum hysterectomy, prior caesarean delivery increases the incidence of this procedure from 1 in 30.000 to 1 in 220. The associated mortality is declared to be <1 percent, and the most frequent complications are febrile morbidity, hemorrhage and urinary tract injury. We studied the incidence of peripartum hysterectomy and the most common associated condition of these cases in the Bucharest Emergency University Hospital for a period of six and a half years. Data were retrieved from the statistics department of the hospital. From January first, 2011 to June 26, 2017 in our hospital 21.746 deliveries were registered, of which 55 cases (0.25%) required peripartum hysterectomy. The associated pathologies analyzed were placental disorders (placenta accreta, increta, percreta), placenta previa, preeclampsia, uterine atony, uterine rupture, fibroids, cervical cancer and infection. Also, the rate of admission in the intensive care unit and mortality were analyzed. The obtained results matched with those declared in the literature. The anticipation of the need of peripartum hysterectomy with the proper preparation, counseling and timing is a key element for the future outcome of the case. Knowing the relation of various risk factors with the possible need of this procedure significantly increases the rate of success and decreases the incidence of complications. [ABSTRACT FROM AUTHOR]