Emergency Peripartum Hysterectomy In the Dubai Health System: A Fifteen Year Experience

Objective: To determine the incidence, demographic data, risk factors, indications, outcome and complications of Emergency Peripartum Hysterectomy (EPH) performed in two major tertiary care hospitals in Dubai, and to compare the results with the literature. Materials and Methods: Records of all women underwent EPH from January 2000 to December 2015 in two major tertiary care hospitals in Dubai, were accessed and reviewed. Maternal characteristics, hysterectomy indications, outcome, postoperative complications were recorded, using descriptive statistics to describe the cohort. Results: There were 79 EPH out of 168,293 deliveries, a rate of 0.47/1000 deliveries. The most common indications for hysterectomy were abnormal placentation (previa and/or accreta) and uterine atony. The majority of hysterectomies were subtotal (70%). The complications were dominated by massive transfusion, urinary tract injuries, one case of maternal death and one case of neonatal death. Conclusion: The main indication of the EPH was the abnormal placentation in scarred uterus and uterine atony. The major prevention of EPH is to assess women’s risks and to reduce the number of cesarean section deliveries, by limiting the rate of the primary cesarean. This is challenging in UAE where cultural life goes with high gravidity and high parity. Recommendations to act to reduce the primary and repeated cesarean should be included on the national agenda in UAE.