Obstetric hysterectomy: analysis of 50 cases at a tertiary care hospital

Abstract

Background: Despite advances in modern medical sciences, there is a plethora of morbidity which continues to affect women during childbirth, necessitating removal of the uterus in the peripartum or postpartum period. This study analyses 50 cases of obstetric hysterectomy done in a single institute. Methods: After Institutional Ethics Committee approval, a retro prospective analysis of hospital records of 50 cases of obstetric hysterectomy was done over a five year period in the department of obstetrics and gynaecology at a tertiary care referral centre-KEM hospital. Results: During the study period, there were 50 cases of obstetric hysterectomy out of 43839 deliveries giving an incidence of 0.12%. Mean age of women undergoing obstetric hysterectomy was 29.9 years. 86% of these were multiparous. The most common indication was morbidly adherent placenta (38%) followed closely by followed by rupture uterus (34%) and uterine atony (20%). Total hysterectomy was the most preferred type of hysterectomy (74%). Urinary tract injury and hypovolemic shock were the most frequently encountered complications. The maternal mortality rate in our study was 4%. 86% of the babies born had Apgar score of 9/10. 44% of babies required admission to neonatal intensive care unit.19.6% of the patients had still born babies and there were 4 neonatal deaths. Conclusions: Obstetric hysterectomy is associated with increased risk of maternal and perinatal morbidity and mortality.

Morbidity and mortality associated with emergency obstetric hysterectomy: a three year retrospective study in a tertiary care centre of India

“…Incidence in this study is very similar to studies done by Shirodker SD et al and Mayadeo NM et al 7,8 Although the incidence is higher than many other studies done in developed countries and in India because this institution is an important referral centre in this region and most (59.6%; 31/52) of these cases were referred from outside centres in moribund condition after complications have already occurred. [9][10][11] However incidence of EOH was as high as 0.54% and 0.37% in studies done by Singh et al and Sharma et al, respectively.…”

Emergency peripartum hysterectomy in a tertiary hospital in Antananarivo, Madagascar

“…Present study is similar to what Mayadeo et al found in India and Abasiattai in Nigeria. 12,14 In this study, uterine atony and uterine rupture are the main causes. Primiparous and pauciparous women who have attempted vaginal delivery outside a health centre are the most affected.…”

“…In India this rate varies from 0.12% to 0.57%. [9][10][11][12][13] In Africa, this prevalence varies between 0.2% and 0.62%. [14][15][16] The highest frequency is reported by Nayama et al, in Nigeria.…”

“…In India, the average age varies between 29.9 years old and 30.25 years old. 12,23 In developed countries, the average age varies between 34.47 and 35.2 years old. 19,24 A recent meta-analysis found an average maternal age between 26.2 and 37.9 years old.…”

“…29 In India, this rate varies between 26% and 88.09%. 11,12,23,30 Total hysterectomy is indicated for placenta accreta, which is the main indication in developed countries. Indeed, subtotal hysterectomy is indicated if the source of the bleeding is upstream of the lower segment.…”