Haemostatic hysterectomies in developing countries: A vital act. Prospective study in a reference Nigerian maternity

The purpose of our prospective study was to determine the frequency, the main indications and difficulties of coverage of the peripartum haemostatic hysterectomy in a developing country. The secondary purpose was to assess the maternal forecast and suggest suited management and to estimate the necessary material and human means to reduce the incidence of this surgery. We realized a forward-looking monocentric study in the Issaka Gazobi maternity of Niamey, between January 1st, 2003 and December 31st, 2003. 3255 deliveries took place, and 41 peripartum haemostatic hysterectomies for post-partum haemorrhage were realized (ie 1.26%). The mean age of our patients was 32.76. The multiparous (more than 5 children) were most often concerned. The majority of patients had benefited from an in utero transfer. 31 patients presented an active bleeding, 11 were in a state of shock during the admittance. The main indications of hysterectomies were represented by an abruptio haematoma, uterine inertia, a rupture of the uterus, a wound of the genital field, 1 placenta accreta with uterine inversion. In a third part of the cases a disseminated intravascular coagulation was associated to the clinical picture. The hysterectomy was subtotal in most of the cases. Finally, the rate of maternal death is high in our series. Prevention of post-partum haemostatic haemorrhage and new therapeutic strategies are essential to reduce the rate of haemostatic hysterectomy in our regions, and improve the coverage of this pathology. However, it is a vital surgery which must be technically mastered.