"Near miss" obstetric morbidity in an inner city hospital in Saudi Arabia

A defined "near-miss" end-point, e.g. peripartum hysterectomy, is a more useful measure of obstetric care in a modern inner-city hospital than maternal mortality. Thus, indication[s], type of operation, risk factors and surgical morbidity of all cases of peripartum hysterectomy conducted over a period of 85 months at King Abdul Aziz Hospital, Jeddah were reviewed. The incidence of hysterectomy was 1.22 per 1000 deliveries. Atonic postpartum haemorrhage was the most common reason [43.5%], followed by ruptured uterus [30.4%] and placenta accreta [26.1%]. Of the atonic group, five patients were primigravidae, three of whom had severe pre-eclampsia. Abnormally prolonged labour was noted in this group. In the uterine rupture group, only two patients had had previous caesarean sections. In the placenta accreta group, three patients had placenta praevia, two of whom had scars from previous caesarean sections. One maternal death was attributed to amniotic fluid embolism