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

Objectives: To determine the incidence, indications, maternal and perinatal outcome of obstetric hysterectomy. Materials and Methods: A retrospective study of 80 women who had obstetric hysterectomy at the Obstetric unit of the University of Port Harcourt Teaching Hospital, (UPTH) Nigeria, between January 1, 2007 and December 31, 2011 was conducted. Data was obtained from the theatre records, labour ward register and case notes of patients and entered into a proforma. Epi Info Version 6.04d was used for data analysis. Results: The prevalence of obstetric hysterectomy during the period under review was 5.3/1000 births. The most common indication was uterine rupture (57.1%), followed by haemorrhage due to uterine atony (25.7%). The mean age of the patients was 28.1 ± 1.78 years, and it was commoner in the Para 1-2 group (40%). Majority (94%) of the patients were transfused and the average unit of blood transfused was 5. The crude morbidity rate was 66.3% with anaemia occurring in 40% of the women. There were 26 maternal deaths, giving a maternal mortality ratio of 325/100,000 deliveries. Twenty-four (92.2%) maternal deaths were unbooked while 2 (7.8%) were booked (p < 0.05). Half (50%) of the women died from primary post-partum haemorrhage. The overall perinatal mortality rate was 575/1000 births. Conclusion: Uterine rupture and postpartum haemorrhage due to uterine atony were the most common indications for obstetric hysterectomy. Maternal death was significantly higher among the unbooked. Effective antenatal care and availability of skilled attendants at all deliveries will reduce the incidence, morbidity and mortality from obstetric hysterectomy.