Prevalence and Characteristics of Emergency Peripartum Hysterectomy (Eph) in A Tertiary Hospital, South-East Nigeria

Adiri Charles O¹, Okoro Onyemaechi S^1, , Nwankwo Theophilus O¹, Nnagbo John-paul E¹, Nnaji Henry C¹, Eze Matthew I¹, Agu Polycarp U¹, Achara John I¹, Ifezuoke Dickson T¹, Asimadu Eric E¹ and Nkwo Peter O¹

¹Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Nigeria

Cite this paper:
Adiri Charles O, Okoro Onyemaechi S, Nwankwo Theophilus O, Nnagbo John-paul E, Nnaji Henry C, Eze Matthew I, Agu Polycarp U, Achara John I, Ifezuoke Dickson T, Asimadu Eric E and Nkwo Peter O. Prevalence and Characteristics of Emergency Peripartum Hysterectomy (Eph) in A Tertiary Hospital, South-East Nigeria. American Journal of Clinical Medicine Research. 2026; 14(2):41-47. doi: 10.12691/ajcmr-14-2-4

Abstract

Background: Post partum hemorrhage is an important cause of maternal mortality globally. Emergency peripartum hysterectomy is a life saving surgery performed to control bleeding in patients with post partum hemorrhage in whom all other conventional methods have failed. Previous studies done in our centre over a decade ago, reported higher prevalence of EPH compared to developed world. Objectives: This study was conducted to determine the current prevalence and indications for EPH in our environment. Methods: This was a cross sectional retrospective study of all the patient that had EPH between January 2016 to December 2025 in University of Nigeria Teaching Hospital, Enugu. The demographic data, risk factors, indications and outcome including (blood transfusion, bladder injuries, bowel injuries, febrile morbidity, ICU admission, and maternal mortality, were recorded. Patients who had EPH at delivery or within 24 hours after delivery, and at gestational age of 28 weeks and above were included in the study. All patients who had EPH after 24 hours of delivery or before 28 weeks gestation were excluded. Descriptive statistics were used to analyze the data. Results: A total of 6115 deliveries were recorded during the period of study out of which 22 had EPH, giving a prevalence of 0.36% of all deliveries (3.6/1000 deliveries). Of the 22 EPH recorded, 20(90.9%) were performed for caesarean delivery while 2(9.1%) were performed for vaginal delivery. Majority of the patients belong to the age group 31-40 year (63.64%) and the mean age of patients was 35.4±7.1 years. Of the 22 patients that had EPH, only 8(36.4%) booked for antenatal care in our hospital, while 14(63.6%) were unbooked. Most of the women 16(72.10%) had parity between 1-3. Thirteen women (59.10%) had no previous scar, while 8(36.40%) had only one previous scar. The most common indication for EPH/ was ruptured uterus 8(36.4%), closely followed by uterine atony 7(31.8%). Placenta accreta and presence of multiple uterine fibroids accounted for 6(27.3%) and 1(4.5%) respectively. All the patients that had EPH received blood transfusion, 19(86.36%) had febrile morbidity, 6(27.22%) had ICU admission, 3(13.64%) had bladder injuries, 3(13.64%) had DIC, while 4(18.18%) had bowel injury. Conclusion: The prevalence of EPH is still unacceptably high in our environment, compared to developed countries of the world from this study. Uterine rupture was the most common indication for EPH in this study and most of the patient that had uterine rupture were unbooked patient. Therefore, all measures should be adopted to ensure that all pregnant women book for antenatal care.

Keywords:
EPH Prevalence Characteristics Tertiary Enugu Nigeria

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Abiodun Omole-Ohonsi (2012). Emergency Peripartum Hysterectomy, Hysterectomy, Dr. Ayman Al-Hendy (Ed.), ISBN: 978-953-51-0434-6, In Tech, available: http// books/ hysterectomy/ emergency-peripartum-hysterectomy.
[2]	Nwobodo E, Nnadi D. Emergency Peripartum Hysterectomy in Tertiary Hospital in Sokoto, Nigeria. Ann Med Health Sci Res. 2012, vol 2, issue 1.
[3]	Machado L. Emergency Peripartum Hysterectomy: Incidence, Indications, risk factors and outcome. N Am J Med Sci 2011 Aug; 3(8): 358-361.
[4]	Obiechina N, Eleje G, Ezebialu I, Okeke C, Mbamara S. Emergency Peripartum Hysterectomy in Nnewi, Nigeria: A 10-year review. Nig J Clin Pract. Apr-Jun 2012. Vol 15. Issue 2.
[5]	Ozumba BC, Mbagwu SC. Emergency Obstetric Hysterectomy in southeastern Nigeria. Int Surg 1991; 76: 109-11.
[6]	Stance LM, Schrimmer OB, Paul RM, Mishell DR.Emergency Peripartum Hysterectomy and Associated Risk Factors. Am J Obstet. Gynaecol. 1993; 168: 879-83.
[7]	Umezurike C, Feyi-waboso P, Adisa C. Peripartum Hysterectomy in Aba southeastern Nigeria. Aust. NZ J Obstet Gynecol 2008; 48: 580-2.
[8]	Ahmet Y, Ali Irfan G, Kadir K. Emergency Peripartum Hysterectomy: 16-year experience of a medical hospital. J Chin Med Assoc. July 2010. Vol. 73. No. 7.
[9]	Chibber R, Al-HIjji J, Fouda M, Al-Saleh E, Al-Adwani A, Mohammed A. A 26-year Review of Emergency Peripartum Hysterectomy in a Tertiary Hospital in Kuwait-Years 1983-2011. Med Princ. Pract. 2012; 21: 217-222.
[10]	Carvalho J, Cubal A, Torres S, Costa F, Carmo O. Emergency Peripartum Hysterectomy: A 10-year Review. ISRNEmergency medicine 2012.
[11]	Ashraf S, Gul Y, Sadiq Malla M, Regoo F. Emergency Peripartum Hysterectomy at a Tertiary Care Hospital in Kashmir Valley. J Evolution Med Dent Sci. 2014; vol. 4, issue 3 pg 400-407.
[12]	Park EH, Sachs BP. ”Postpartum Haemorrhage and other problems in third stage” in High Risk Pregnancy- Management options, James DK, Steer CP. Weiner and B. Gonik , Eds. Pg 1231-1246, WB Saunders, Philadelphia, Pa, USA, 2nd ed. 1999.
[13]	Kwee A, Bots M, Visser G,Bruinse H. Emergency Peripartum Hysterectomy: A Prospective Study in the Netherlands. Euro.J Obstet Gynaecol. Repro, Biol. 2005, 124(2): 187-92.
[14]	Madhura B.Emergency Peripartum Hysterectomy: Experience of a Tertiary Care Hospital in south India. Asian pac.JHealth Sci. 2015; 2(4) 42-46.
[15]	Okafor UV, Ezegwui HU, Okezie O. Anaesthetic Challenges in Emergency Peripartum Hysterectomy in West Africa: A Nigerian Perspective. S. Afr. Anaesthesiol. Analg 2010; 16(5): 8-11.
[16]	Banks C, Paterson A, Thomson A. Caesarean Hysterectomy. Glob. libr. women’s med., (ISSN: 1756-2226) 2011.
[17]	Chukudebelu WO, Ozumba BC. Maternal Mortality at the University of Nigeria Teaching Hospital Enugu: A ten-year Survey. Trop. J Obstet Gynaecol. 1988.1(1)23-6.
[18]	Obi SN, Ozumba BC, Okaro JM. Emergency Obstetric Referrals at University of Nigeria Teaching Hospital, Enugu, Nigeria. East Afr Med J. 2001. 262-264.
[19]	Rasul S. Tahir S. Riaz L. Gul A. Clinical Analysis of Emergency Peripartum Hysterectomy. J. Rawal Med. College; 2016; 20(2): 132-135.
[20]	Zheng J, Xiong X, Ma Q. A new uterine compression suture for postpartum heamorrhage with atony. BJOG 2011; 118(3): 370-74.
[21]	Kaya B, Tuten A, Daglar K. B Lynch uterine compression suturs in the conservative management of uterine atony. Arch Gynecol Obstet 2015; 291(5): 1005-14.
[22]	Korejo R, Nasir A, Yasmin S. Emergency obstetric hysterectomy. J Pak Med Assosci. 2012; 62(12): 1322-25.