Outcomes in failed Primary Peripartum Hysterectomy for massive postpartum heamorrhage as compared to patients undergoing Peripartum Hysterectomy with internal iliac artery ligation.

Objective: To evaluate the outcomes in patients undergoing peripartum hysterectomy alone for massive primary postpartum haemorrhage (Peri-hyst) compared to a patient undergoing Emergency peripartum hysterectomy with bilateral internal iliac artery ligation. (Peri-hyst + BIIAL). Methods: It was a cross-sectional comparative study conducted over two years from April 2021 to March 2023, conducted in OBGYN department of Lady Reading Hospital, Peshawar, KPK. The primary outcome was the failure of primary procedure in both group to control blood loss and required relaparotomy. Group-1 were patients undergoing pripartum hysterectomy alone and was compared with Group-2 of the patient in whom bilateral internal iliac artery ligation was also carried out at the time of Peripartum hysterectomy (Peri-hyst +BIAAL). Secondary outcomes analyzed were complications like damage to structure like ureters or sigmoid colon, internal iliac vein injury and haematoma formation in both procedures. Results: When we compare the mean outcomes of both groups by t test, it is seen that group-I had more ICU admission 15(57.7%) verses 11(42.3%), more maternal morbidity in ICU and more maternal deaths Five (55.6%) versus 4(44.4%) massive heamorrhage 25(65.8%)versus 13(34.2%), acute renal failure, acute respiratory failure p=0.818. Conclusion: Failed primary surgical management to control haemorrhage without BIIAL leads to grave outcomes as seen in most admission in ICU and maternal deaths. Early resort to IIAL is vital for improving the patient outcome when they present with massive haemorrhage.