Emergency obstetric hysterectomies in a tertiary care centre of rural India

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.