Prevalence and factors associated with emergency Peripartum Hysterectomy among women with Post Partum Haemorrhage at Kawempe National Referral Hospital: a retrospective cross- Sectional analytical study.

Abstract

Background Emergency peripartum hysterectomy (EPH) is a treatment modality performed as a life-saving intervention in PPH refractory to conservative management. EPH is associated with high maternal morbidity and mortality but there is limited evidence on factors associated with it in sub Saharan Africa where PPH remains the leading cause of maternal death. This study aimed at determining prevalence and factors associated with EPH among postpartum women who experienced PPH at KNRH to inform innovative interventions for prevention of EPH burden. Study Objective To determine prevalence and factors associated with EPH among women with PPH at KNRH. Study methods This was a retrospective cross-sectional analytical study conducted at KNRH by reviewing records of 358 mothers who had PPH between January and December 2021.Participants were consecutively enrolled in the study. A data abstraction tool was used to abstract data on sociodemographic, antenatal, delivery and health system related factors for EPH among mothers with PPH. Continuous variables were analyzed using a T-test model and categorical variables were analyzed using Chi square test. To determine factors associated with EPH, data was analyzed using STATA version 16.0 at bivariate and multivariate level for crude and adjusted odds ratios respectively. At multivariate analysis, variables with p- values of ˂0.05 were considered statistically significant. Results. A total of 358 participants were enrolled into the study. The mean age of the participants was 27.3 years. The prevalence of EPH was 7.5 % (27 out of 358).The factors that were independently associated with EPH were; rural residence(AOR=3.12;95% CI:1.35-2.8;p=0.032),four or more births (AOR = 21.2; 95%CI: 3.7 – 36.5; p = 0.002),previous caesarean section (AOR=9.3;95%CI:3.4-17.8;p=0.0001),more than two previous caesarean sections (AOR=6.4;95%CI:2.5-11.7;p=0.031),admission in labour at health centre (AOR=3.18;95%CI:1.64- 8.94;p=0.004),caesarean mode of delivery(AOR=7.7;95%CI:3.3-19.5;p=0.002),abnormal placentation (AOR=12.6;95%CI:3.8-25.6;p=<0.0001) and uterine rupture (AOR = 18.5; 95% CI:6.9 – 36.8; p = <0.0001). Conclusion This study found a very high prevalence of EPH among women with PPH at KNRH. Efforts should focus on reducing caeserean section rates, increasing the uptake of family planning and improving access to emergency obstetric care.