Introduction: Postpartum hemorrhage is the leading cause of maternal mortality.  Emergency peripartum hysterectomy (EPH) is a challenging live saving treatment modality in such circumstances. The incidence of EPH is 1 per 1,000 deliveries (range 0.2-10.1). Meta-analysis suggested that emergency hysterectomy rates have been increasing by about 8% per year worldwide. However, there is a lack of Malaysia data on EPH.

Objective: To study the incidence, risk factor, indications, outcomes and complication of EPH in a tertiary hospital setting.

Methodology: Retrospective study carried out in the Department of Obstetrics and Gynaecology in Hospital Sultan Ismail (HIS) from January 2014 to December 2016.

Results: During the study period, total of 36,559 deliveries of which 30,453 vaginal deliveries and 6,106 were CS. There were 25 cases with overall incidence at the rate of 0.68 per 1,000 births. The rate of EPH was 3.76/1,000 CS deliveries and 0.06/1,000 vaginal deliveries. The mean maternal age was 34 years (25.0, 42.0) and parity 3 (2.0, 6.0) and 64% Malay, 24% Chinese, 8% Indians and 1 % others.

The most common indication for EPH was morbid adherent placenta 20 cases (80%), uterine atony 3 cases (12%) and cervical cancer 2 cases (8%). Placenta previa was a significant risk factor.  The most cases contribute to EPH was delivery via emergency CS (64%), elective CS (28%) and spontaneous vaginal delivery (2%). The mean gestational age of delivery was 34 weeks with a birth weight of 2,359 grams with a mean Apgar of 7 in 1 minutes. 76% of newborn admitted for intensive care with one case of neonatal death. Measures used to treat postpartum hemorrhage included oxytocin infusion in all cases, prostaglandin usage in 24% of cases, tranexemic acid (32%), Bakri balloon (4%), internal iliac ligation (32%) and B lynch (12%). Total abdominal hysterectomy was performed in 21 cases (84%) while subtotal hysterectomy in 2 cases (8%). Wertheim hysterectomy was performed in 2 cases (8%) with concurrent cervical cancer. Mean operative times was a 177 minutes with a mean of blood loss of 5,412 mls. (500, 17000).

Major maternal morbidity of EPH included massive blood transfusion with mean 5.8 pint of pack cell, DIVC (64%), wound infection (4%), fever (4%), paralytic ileus (16%), postoperative anemia (52%), ventilator support (60%), bladder injury (12%), bowel injury (4%) and fistula (4%). There is one maternal death (4%). The mean length of hospital stay was around 6.4 days.

Conclusion: Majority of women who underwent EPH had a favourable outcome after exhausting all other options for postpartum haemorrhage. Further audits are required to maintain the standard of care and to improve services.