A Seven-Year Review of Emergency Obstetric Hysterectomy in a Nigerian Tertiary Institution

Abstract

Background: Extirpative uterine surgeries for near-miss events are usually the last resort when other conservative measures fail. Emergency obstetric hysterectomy (EOH) may still have a significant role where there are limited options. Objectives: To determine the prevalence of EOH, the associated factors and the foeto-maternal outcome at the Olabisi Onabanjo University Teaching Hospital, Nigeria. Methods: This was a retrospective observational study covering seven years (January 2010 to December 2016). The case records of patients who had EOH during this period were retrieved for data extraction. Results: There were 5, 608 deliveries and 31 cases requiring EOH giving a prevalence rate of 31/5,608 (0.55%). The mean age of the patients was 30.3±4.2 years, while the mean gestational age at delivery was 36.3±5.1 weeks. Most of the patients 16/25 (64.0%) were of higher parity (>3), and 12/25 (48%) of the patients were within the age bracket of 25-34 years. Subtotal hysterectomy was the most common procedure (18; 72.0%), and ruptured uterus was the main indication for EOH (40.0%). The two most common interventions that were critical to survival included massive blood transfusion (24.0%) and Intensive Care Unit admission (20%). Two (8%) maternal deaths and 58.3% perinatal mortality were recorded. Conclusion: EOH is still relatively frequently performed at this centre due to the high incidence of a ruptured uterus. Efforts should be made to increase the proportion of deliveries attended by skilled personnel and improve the capacity of lower level hospitals for comprehensive emergency obstetric care.