The Prevalence, Incidence, Indications and Outcomes of Peripartum Hysterectomy in Kazakhstan: Data from Unified Nationwide Electronic Healthcare System 2014-2018

Gulzhanat Aimagambetova; Yesbolat Sakko; Arnur Gusmanov; Alpamys Issanov; Talshyn Ukybassova; Gauri Bapayeva; Aizada Marat; Aiymzhan Nurpeissova; Abduzhappar Gaipov

doi:10.2147/IJWH.S343387

The Prevalence, Incidence, Indications and Outcomes of Peripartum Hysterectomy in Kazakhstan: Data from Unified Nationwide Electronic Healthcare System 2014-2018

Int J Womens Health. 2022 Feb 21:14:267-278. doi: 10.2147/IJWH.S343387. eCollection 2022.

Authors

Affiliations

¹ Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan.
² Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan.
³ School of Population and Public Health, University of British Columbia, Vancouver, Canada.
⁴ Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan.
⁵ Department of Obstetrics and Gynecology #1, NJSC "Astana Medical University", Nur-Sultan, Kazakhstan.
⁶ Department of Medical Information Analysis of Outpatient and Polyclinic Care, The Republican Center of Electronic Healthcare, The Ministry of Healthcare of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan.

^# Contributed equally.

Abstract

Purpose: Peripartum hysterectomy is a surgical procedure performed as a life-saving surgery to manage severe postpartum hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. However, maternal mortality due to postpartum hemorrhage and after peripartum hysterectomy remains high in developing countries. To date, there is a lack of information about the rates of peripartum hysterectomy and its common indications in Kazakhstan. Objectives were to study the prevalence, indications, and outcomes of peripartum hysterectomy using nationwide large-scale health-care data from the national registry.

Patients and methods: We performed a descriptive, population-based study among women who underwent a peripartum hysterectomy in any health-care setting of the Republic of Kazakhstan during the period of 2014-2018. Data were collected from the Unified Nationwide Electronic Health System (UNEHS).

Results: Data included 3838 medical records of women who had a peripartum hysterectomy performed due to specific indications for the period of 5 years (2014-2018). The median age of the participants was 33 years old, with 60.7% of women aged between 18 and 34 years. The leading indications for peripartum hysterectomy were intrapartum hemorrhage (IPH) and postpartum hemorrhage (PPH) reported in 60% of the cases analyzed. The second most common indication was placental pathology - placental abruption and placenta previa in 9.6% and 7.9% of cases, respectively. In 1633 cases (42.4%), total abdominal hysterectomy was performed, while subtotal hysterectomy was done in 2195 cases (57.0%). Based on these data, the estimated prevalence of peripartum hysterectomies was calculated: overall weighted mean prevalence 1.93 per 1000 deliveries.

Conclusion: IPH and PPH are the commonest indications for peripartum hysterectomy followed by placental pathology. Appropriate maternal care during labor and delivery should be reinforced to decrease the incidence of peripartum hysterectomy in Kazakhstan.

Keywords: Kazakhstan; epidemiology; maternal mortality; peripartum hysterectomy; postpartum hemorrhage.

Grants and funding

This study was supported by grants from the Nazarbayev University Faculty Development Research Grant Program FDCRGP 2020–2022 (Funder Project Reference: 240919FD3913). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. A.G. is a PI of the projects.