Abstract
Introductionemergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies. We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre.Methodsan ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1st January 2018 to 31st December 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables.Resultsthere were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH): 73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as ‘others **’: two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products.Conclusionemergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team.
Highlights
Hysterectomy has been a common gynaecological operation for generations, and it is the most common major gynaecological operation performed worldwide [1,2], being the second most frequent surgical operation performed on women after caesarean section [3]
Abnormal placentation, is thought to be increasing and overtaking uterine atony as the major cause of obstetric haemorrhagebecause of the rising rate of cesarean section [8]. This trend may not be the case in developing countries as apart from the increase in the incidence of morbidly adherent placenta due to the increasing caesarean section rate, uterine atony and uterine rupture continue to be major causes of major obstetric haemorrhage
Potential maternal complications include hypovolemic shock, disseminated intravascular coagulopathy, renal failure, hepatic failure, adult respiratory distress syndrome (ARDS) [11,12] and surgical complications such as injury to viscera and blood vessel and maternal death. This retrospective study was aimed at examining the indications, surgical outcomes, complications and challenges of emergency hysterectomy (EH) performed in a tertiary teaching hospital over a 2-year period
Summary
Hysterectomy has been a common gynaecological operation for generations, and it is the most common major gynaecological operation performed worldwide [1,2], being the second most frequent surgical operation performed on women after caesarean section [3]. Abnormal placentation, is thought to be increasing and overtaking uterine atony as the major cause of obstetric haemorrhagebecause of the rising rate of cesarean section [8]. Potential maternal complications include hypovolemic shock, disseminated intravascular coagulopathy, renal failure, hepatic failure, adult respiratory distress syndrome (ARDS) [11,12] and surgical complications such as injury to viscera and blood vessel and maternal death. This retrospective study was aimed at examining the indications, surgical outcomes, complications and challenges of EH performed in a tertiary teaching hospital over a 2-year period (between 1st January 2018 and 31st December 2019). The findings will help in planning, organization of health care services, staff training and patient education to help reduce maternal morbidity and mortality from massive obstetric haemorrhage
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