No abstract

Objective: Though unusual in modern obstetrics, emergency obstetric hysterectomy remains a lifesaving procedure in case of uncontrollable postpartum hemorrhage. Decision of proceeding for obstetric hysterectomy on time will save one life. Because of its own significance, a study was conducted to analyse emergency obstetric hysterectomy in various aspects. Here we sought to determine incidence, risk factors, age distribution, parity association, feto-maternal outcomes, indications, post-operative complications and prognosis associated with emergency obstetric hysterectomy. Materials and Methods: A descriptive observational study was conducted as a retrospective analysis of 34 patients over a span of 2 years from January 2018 to December 2019 in the department of obstetrics and gynecology at Government Medical College & hospital a tertiary care centre in Latur, Maharashtra. All the peripartum hysterectomy cases were analysed under various factors and its outcome regarding maternal morbidity and mortality. Results: The incidence of obstetric hysterectomy was 2.03 per 1000 confinements. Majority of the women were in the age group of 21 to 25 years contributing 35.20% and belonged to parity two and above. The commonest indication was postpartum hemorrhage (64.70%) followed by morbidly adherent placenta (17.64%). Previous cesarean section was the most common risk factor (35.29%). Among the post operative complications, febrile morbidity remain the most common (35.29%). There were five maternal deaths (14.70%). Conclusion:Providing the universal proper antenatal care to identify the risk pregnancy, there should be increased frequency of ANC visits in case of high risk cases for timely diagnosing the condition and to prevent the deadly complication further. Referral to higher centre for medically supervised delivery for timely intervention if needed and that can reduce emergency obstetric hysterectomy and finally lead to reduction in maternal morbidity and mortality.

Background: Obstetric hysterectomy (OH) is indicated as last resort operation to save the life of the mother  and associated with high complication rates, so  requires a highly experienced and skilled medical team ,to solve any complication. Objective was to identify incidence, demographic profile, indications, risk factors, complications, maternal morbidity and mortality associated   with   obstetric hysterectomy.Methods: Retrospective   analytical study of 47 case records is done over period of last 5 years   from October 1st October 2015 to 30th September 2020 at VDGIMS, a tertiary care center, Latur. Results are expressed in frequency and percentages.Results: In our study, the rate of OH was 1.1/1000 deliveries. Most common (68%) age group was 21-30 yrs, majority (70%) were multipara, and booked (76%). Most common indication of OH was atonic PPH (65%), followed by traumatic PP, including rupture uterus (21%), and placenta acreta (10%). Most OH was performed on emergency basis (91%) and of subtotal type (95%). Major mode of delivery  was cesarean 65% and vaginal delivery in 21% cases. Most common risk factors were placental causes (55%), previous LSCS (48%) and hypertensive disorder (31%). High maternal morbidity in form of 100% blood transfusion rate, 93% ICU admission, inotropes and ventilator support in 59% cases and prolonged hospital stay in 75% cases seen. Most common complication were hemorrhagic shock 21%, DIC (29%), renal failure (12%) and septic shock (14%) with maternal death rate of 23% was noted.Conclusions: Obstetric hysterectomy is a necessary life-saving operation, but also associated with high maternal morbidity and mortality, which can be minimized with timely done procedure by experienced person.

We are reporting a rare case of partial molar pregnancy coexisting with live fetus termed as sad fetus syndrome. Our case was a 20 years old primi with 18 weeks of gestational age showing partial molar pregnancy coexisting with anomalous fetus with low lying placenta presented with complaints of abdominal pain and per vaginal bleeding. Initially we tried to conserve the pregnancy but she continued on per vaginal bleeding. On the basis of maternal health and fetal prognosis, we decided to terminate the pregnancy with their consent. All the preoperative evaluations were done along with physician and anesthesiologist fitness and she had underwent operative procedure such as hysterotomy. Her post operative course in the hospital was uneventful. We had done post op abdomen with pelvis ultrasound sonography and chest X ray reported as normal. Later she was discharged with contraceptive and advised for monthly regular follow up with beta-human chorionic gonadotropin levels (β-hCG).