Role of Emergency Hysterectomy in Modern Obstetrics

A retrospective study was done to estimate prevlance, indications and complications of emergency hysterectomy done for various obstetric indications over two years was carried out. There were 37549 confinements during study period from April 2006 to Aug 2008. Out of this 27213 (72.4%) delivered vaginally and 10336 (27.5%) by Cesarean section. 80 emergency hysterectomies were done, incidence being 2.13 /1000 births. Mean age was 30.5 years. Majority (75%) were from rural areas. Maximum cases were para 2-4. Most common indication for emergency hysterectomy was uterine rupture (40%) followed by atonic PPH (28.75%). Placenta previa (9%). Secondary PPH (6.25%), broad ligament hematoma (6.2%) placenta accreta &increta (2%).fibroid with bleeding (3.7%). Couvelaire uterus (2.1%) and obstructed labour with septicemia (1.2%). Majority of uterine rupture cases were late referrals from rural areas. Out of 32 cases of rupture uterus 20 were with previous LSCS and 12 were multipara. Maternal mortality was 2.5% and the cause of death was related to irreversible shock and DIC. Identification of high risk cases, early referral and procedures like internal illiac artery ligation can reduce the incidence of Emergency Hysterectomy