Critical Appraisal of Obstetric Hysterectomy from a North Indian Tertiary Care Health Facility over a Fifteen Year Period

Abstract

Aims & Objectives: (a) To critically analyse obstetric hysterectomies in a tertiary care government centre over a period of one year in relation to incidence, indication and risk factors, and maternal and perinatal outcome. (b) To compare the present data with similar data collected seven years and fourteen years back in same hospital. Methods: All the patients undergoing obstetric hysterectomy during the period from January 2016 to December 2016 in department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi were included in th e study. Their detailed obstetric history, indications leading to hysterectomy, risk factors, postoperative maternal complications and perinatal outcome was noted, analysed and compared to similar data collected in the year 2001 and 2008 in Safdarjung hosp ital. Results: The incidence of obstetric hysterectomy in the year 2016 was 1.89/1000, 0.8/1000 deliveries in 2008 and 1.5/1000 deliveries in 2001. Maternal mortality was 34.6% in 2016, 18.28% in 2008 while 20.68% in 2001. The main indications leading to hysterectomy were rupture uterus, atonic postpartum haemorrhage (PPH), abnormal placentation, secondary PPH all these years. Perinatal outcome was comparable over the 15 year study period. Conclusion: Though incidence of obstetric hysterectomy had slightl y decreased over the years initially, but owing to influx of more unbooked cases in grave condition, it has shown a gradual increase in 2016. This underlines the absence of much necessitated improvement in the community health services, which is especially evident by high percentage of obstructed labour cases contributing to hysterectomy.