Sepsis: Primary indication for peripartum hysterectomies in a South African setting
CITATION: Jansen Van Vuuren, L & Cluver, C. A. 2016. sepsis: Primary indication for peripartum hysterectomies in a South African setting. South African Journal of Obstetrics and Gynaecology, 22(2):52-56, doi:10.7196/SAJOG.2016.v22i2.1068.
The original publication is available at http://www.sajog.org.za/index.php/SAJOG
BACKGROUND: Peripartum hysterectomies are lifesaving procedures but definitions vary. Indications are variable and dependant on resources and geographical factors. OBJECTIVES: This study evaluates the incidence, aetiology and complications associated with peripartum hysterectomies in a tertiary hospital in South Africa. METHODS: A retrospective audit at an academic referral center over a five year period from February 2009 to 11 March 2014 was performed. Procedures from a gestational age of 24 weeks until six weeks postpartum were included. One hundred and sixty cases met inclusion criteria. Nine case records were unavailable. The incidence was 2,77 per 1000 deliveries. Main indications were sepsis (60, 39,7%), uterine atony (24, 15,9%), morbidly adherent placenta (21, 13,9%), tears (14, 9,2%), uterine rupture (8, 5%), placenta praevia (7, 4,6%) and unclassified bleeding (6, 4%). There were 6 maternal deaths. Five related to sepsis and one to hypovolaemic shock. One hundred and thirty eight (91,4%) women required high or intensive care admission. CONCLUSION: Sepsis is an important aetiology for peripartum hysterectomies, particularly in Southern Africa. The high rate of sepsis may be due to HIV infection, low socio-economic standards, late diagnosis, limited access to health care, sterility issues and differences in the definition and inclusion criteria used for a peripartum hysterectomy.