Obstetric hysterectomy: fifteen years' experience in a Nigerian tertiary centre

Abstract

The aim of this study was to determine the incidence, indications, associations and complications of obstetric hysterectomy in our centre with a view to suggesting ways of improving outcome. This is a descriptive study of patients who had obstetric hysterectomy in the University of Benin Teaching Hospital from January 1986 to December 2000. Data obtained from hospital records were analysed using appropriate computer statistical software for graphs and chi(2) test. In the period under study there were 20 344 deliveries. There were 46 obstetric hysterectomies, resulting in an incidence of 0.226%. Incidence increased with increasing maternal age from 0.10% at 20 years to 0.706% at 40 years and above. Incidence also increased with parity from 0.028% at para 0 to 1.298% for grandmultiparous women. The indications for the procedure were ruptured uterus 14/40 (35.0%), atonic postpartum haemorrhage 13/40 (32.5%) and placenta praevia 9/40 (22.5%); 12/40 (30.0%) of patients had previous caesarean sections. Subtotal hysterectomy had been undertaken in 43.5% of cases. There was a maternal mortality rate of 12.5%. Mortality was associated with torrential continuing haemorrhage and septicaemia. Urinary tract injury occurred in 7.50% of patients. Injury to the urinary tract was associated with previous caesarean section and total hysterectomy. Obstetric hysterectomy can have grave consequences. Availability of blood products, intensive monitors and limitation of family size is advised.

Peripartum hysterectomy: Two years experience at Nelson Mandela Academic hospital, Mthatha, Eastern Cape South Africa

“…The study showed an association between increasing age and increasing parity with increasing incidence rate of peripartum hysterectomy. It identified age more than or equal 30 years and parity more or equal to four as risk factors for peripartum hysterectomy and this has been reported in West Africa 2,19 .…”

Obstetric Hysterectomy Performed at N’Djamena Mother and Child Hospital (Chad): Indications and Prognosis

“…In the developing world, preventable factor such as uterine rupture or uterine atony are the most common indication for peripartum hysterectomy [4][5][6][7]9,10,13,14,16]. The common causes of uterine rupture in this part of the world include prolonged obstructed labour, rupture of a previous caesarean scar, injudicious use of oxytocics and trauma from instruments or manual removal [3,4,6,11,17,18]. If the rupture is extensive and hemorrhage cannot be controlled by uterine repair, then hysterectomy may become necessary [17].…”

“…The common causes of uterine rupture in this part of the world include prolonged obstructed labour, rupture of a previous caesarean scar, injudicious use of oxytocics and trauma from instruments or manual removal [3,4,6,11,17,18]. If the rupture is extensive and hemorrhage cannot be controlled by uterine repair, then hysterectomy may become necessary [17]. Ours findings confirm this assertion with uterine rupture and uterine atony as main indications of obstetric hysterectomy respectively 63% and 21.7%.…”

Obstetric Hysterectomy As A Surgical Intervention in the Management of Obstetric Haemorrhage At the University of Port Harcourt Teaching Hospital, Nigeria.

“…This is similar to results obtained from centers in Nigeria and other developing countries. [19,20] Studies from developed countries have found placenta praevia and morbidly adherent placenta as the most frequent indications. [21,22] The difference may be due to the increasing caesarean section rate, improved obstetric care, reduced parity and effective family planning and health policies in the developed countries.…”