EMERGENCY OBSTETRIC HYSTERECTOMY

Abstract

Background: Emergency hysterectomy in obstetric practice is generally
performed in the setting of life-threatening hemorrhage which fails to be controlled by
conservative management. Objective: To review 8 years’ experience of emergency obstetric
hysterectomy in a teaching hospital. Study Design: A retrospective descriptive study based on
hospital data of 156 patients undergoing emergency Obstetric hysterectomy. Settings: Obs. &
Gynae. Department Unit-I, PMC Allied Hospital Faisalabad. Methods: This was a retrospective
review carried out from March 2004 to Feb 2012 Main outcome measures were frequency,
indications, associated risk factors and maternal morbidity and mortality associated with
emergency peripartum/obstetric hysterectomy. Results: During 8 years there were total 156
(0.38%, 3.8 per 1000) emergency obstetric hysterectomies out of which there were 46 caesarian
hysterectomies, 65 post partum, 45 for ruptured uterus with total number of delivery 40062.
Number of hysterectomies was 48 in the first 4 years of the study (March 2004- Feb 2008) and
during the last 4 years (March 2008- Feb 2012) it was 108. Maximum obstetric hysterectomies
were in para 3-5 (53.20%) and in 26-30 years age group (35.89%). The most common indication
for hysterectomy was uterine atony (44.23%) followed by uterine rupture (28.85%), Placenta
accreta (14.745%) and placenta previa (11.53%). The maternal mortality was 6.41% (10
patients). In this series 80% patients were referred from other areas. Conclusions: Frequency
of emergency Obstetric hysterectomy is high in our tertiary center and it is continuously
increasing due to increased referral of patients. The mortality and morbidity of performing
obstetric hysterectomy is higher in patients referred from outside hospital.