Emergency obstetric hysterectomy in a tertiary hospital in Sokoto, Nigeria

Abstract

Background:Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality.Objectives:This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto.Materials and Methods:This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the χ2 test was used to analyze some of the results with the confidence limit set at 95%.Results:During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively.Conclusion:The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

“…The rate of EPH in our centre is similar to what obtains in other Nigerian centres [6–9], and also other centers in sub-Saharan Africa [10]. While it is lower than rates recorded from studies conducted in Pakistan and India in South Central Asia which vary from 0.4% - 0.7% [2, 11, 12], the EPH rate is much higher than those reported from Saudi Arabia (1 in 2,559 deliveries) [1] and the developed countries of America and Europe where the incidence of EPH is approximately 1 in 2000 deliveries [13].…”

“…Interestingly, this is in direct contrast to what obtained in other centres [6, 10, 12, 16] where most of the patients in those series were above thirty years of age and were grandmultiparous hence almost at the end of their reproductive carriers. Sadly, this goes to highlight the adverse reproductive health effects removal of the uterus will have on these patients particularly in an environment like ours where failure of menstruation is perceived by women to be tantamount to loss of their self image and the premium placed on childbearing is very high.…”

Complications of emergency obstetric hysterectomy in Gujarat, India

“…1 As one of the markers of obstetric morbidity, it is one of the most risky and dramatic operations in modern obstetric, where the uterus is removed either during caesarean section or following caesarean section or immediately after vaginal delivery or during period of puerperium to reduce maternal morbidity and mortality. 2 Emergency obstetric hysterectomy (EOH) is defined as extirpation of the uterus either at the time of caesarean section or following vaginal delivery, or within the puerperium period to stop life threatening obstetric haemorrhage when all other measures fail.…”

Emergency obstetric hysterectomy: a retrospective study from a teaching hospital over eight years

“…It is considerably lower than that reported in Columbia (0.8%) Nigeria (0.51%) and similar to China (0.22%) and Pakistan (0.27%). [6][7][8][9] In the developed countries American and Europe where the incidence of EOH is approximately one in 2000 deliveries. 10 The rate of EOH was 3.5 per 1000 caesarean deliveries and 0.4 per 1000 vaginal deliveries.…”