Peripartum hysterectomy in a Nigerian university hospital: An assessment of severe maternal outcomes with the maternal severity index model.

Background: Peripartum hysterectomy is life-saving and a life-threatening criterion of the World Health Organization (WHO) maternal near-miss concept. The maternal severity index (MSI) model was developed to assess the outcome of severe maternal morbidities. This study assessed severe maternal outcomes of peripartum hysterectomy using the MSI model and related maternal severity score with mortality.

Subjects And Methods: Records of women with peripartum hysterectomy over a 20-year period were retrieved and the documented WHO life-threatening conditions (severity markers) extracted. Severity markers were related with booking status, the level of specialist care and mortality. Comparison of dichotomous variables was done with Mantel-Haenszel statistics, and with one-tailed Fisher's exact test when the variable was <5, at 95% confidence interval andP< 0.05.

Results: There were 30,553 deliveries and 145 women had a peripartum hysterectomy with an incidence of 4.8/1000 deliveries. Fifty women (50/116; 43%) had no associated severity markers. Fifty-eight (58/116; 50%) and 5% (6/116) women, respectively, had one and five severity markers. All women without a severity marker survived, but there was an exponential increase in mortality to 20.7% (12/58) in women with massive blood transfusion (MBT) and 66.7% (12/18) in women with both MBT and disseminated intravascular coagulopathy. Overall, peripartum hysterectomy case fatality was 13.8%. Other morbidities were anaemia (100%), febrile morbidities (55.2%), urinary tract infection (20.7%) and ureteric injuries (5.1%).

Conclusion: The onset of severity markers was positively related to mortality. There should be early intervention to improve survival when an indication for peripartum hysterectomy occurs.