Obstetric Hysterectomy: Frequency, Indications and Complications
Farah Deeba Nasrullah, Shamim Haque, Tehmeena Ali
To determine the frequency, indications and complications of obstetric hysterectomy at a tertiary care centre.
Descriptive case series.
Place & Duration of study
Department of Obstetrics & Gynacology Civil Hospital / Dow University of Health Sciences Karachi, from January 2016 to December 2016.
All patients between 20 - 40 years of age, of any parity who underwent obstetric hysterectomy after 24 weeks of pregnancy till 42 days postpartum, were included in this study. Patients who had hysterectomy for non obstetric indications were excluded. Variables assessed included age, parity, booking status, risk factors, frequency, indications and complications related to hysterectomy. Data was analyzed by SPSS Version 17. Frequency and percentages of numeric variables were calculated. Mean and standard deviation was calculated for categorical variables.
During this study period 4296 patients were delivered. Obstetric hysterectomy was performed in 40 (0.93%) patients. Mean age of the patients was 26 year + 3.2 year and mean gestational age 36 + 1.2 week. Majority of the women were non-booked (n=28 - 70%). Most frequent indication was PPH (n=19 - 47.5%). Other indications included uterine rupture (n=14 - 35%) and morbidly adherent placenta (n=6 - 15%). Multiple blood transfusions (>4) were required in 75%. ICU admission was needed in 27 (67.5%) patients. Maternal mortality was 25% (n=10) which occurred due to intractable haemorrhage.
Obstetric hysterectomy was associated with high maternal morbidity and mortality. Risk factors included multiparity and previous caesarean section.
Emergency obstetric hysterectomy (EOH), Morbidly adherent placenta (MAP), Postpartum haemorrhage (PPH).