Frequency, Indications and Maternal Outcome in Obstetric Hysterectomy in a Tertiary Care Centre in India

Emergency obstetric hysterectomy (EOH) is one of the life saving procedure performed in gravid uterus or immediate postabortal or postpartum period in cases of intractable hemorrhage due to uterine atony, rupture uterus, placental disorders, uterine perforation and septic abortion. The procedure is usually reserved for the situations where conservative measures fail to control hemorrhage. Obstetric hysterectomy remains one of the obstetric catastrophes. It is associated with increased maternal mortality, considerable morbidity, and it brings an abrupt and usually unwelcome end to a woman's reproductive potential. (1) In past the most common indication of EOH was atony and uterine rupture. (2) Recent reports show that abnormal placental adherence and placenta previa is emerging as the major indication for EOH and is likely related to increase in the number of caesarean delivery observed over the past two decades. (3) The high incidence of associated morbidity and mortality is reported from developing countries. (4) Material and Methods A retrospective descriptive analysis of 41 cases of emergency obstetric hysterectomies done for any indication during pregnancy, labor, postabortal or puerperium over a period of five years from Jul 2005 to Jun 2010 was done. Each case record was analyzed in details for maternal characteristics (age, parity, booked or emergency cases etc), indications of hysterectomy, Introduction Abstract The aim of present study is to review the frequency, indications, associated risk factors, maternal morbidity, maternal and fetal mortality associated with emergency obstetric hysterectomy in a tertiary care academic referral centre. A retrospective descriptive analysis from Jul 2005 to Jun 2010 was carried out in a tertiary care academic referral centre. Main outcome measures were frequency, indications, associated risk factors, maternal morbidity, maternal and fetal mortality associated with emergency obstetric hysterectomy. There were 41 cases of obstetric hysterectomy over the study period and the frequency of obstetric hysterectomy was 22.9/10,000 births. The incidence of hysterectomy for vaginal delivery was 0.017% and for caesarean section was 0.318%. Maximum number of patients (36.5%) were in the age group 26-30 years. 60.9% patients were antenatally unbooked emergency cases. It was most common in para two (46.3%) followed by para four or more (26.8). Main indications for obstetric hysterectomy were rupture uterus and postpartum haemorrhage (31.7% each) followed by morbidly adherent placenta (21.9%). All women required blood transfusion, 26 (63.42%) were anaemic, 5 (12.19%) required ICU stay. There was one maternal mortality and varied morbidity pattern. 12 fetal mortalities were noted, including 9 for uterine rupture, 2 for placenta previa in scarred uterus and one in obstructed labor case. Emergency obstetric hysterectomy still remains a life saving procedure and complications can be minimized by timely and thoughtful decision. Unnecessary delay or undue haste increase maternal morbidity.