Emergency Obstetric Hysterectomy: 8-Year Review at Taif Maternity Hospital, Saudi Arabia

Abstract

Emergency or obstetric hysterectomy was first performed in the 19th century to reduce the high maternal mortality and morbidity associated with the cesarian procedure. 1 The indications were mainly life-threatening sepsis and hemorrhage. Some years later, other less serious clinical indications, such as sterilization , were included, which gave the procedure a bad reputation. 2 In the last few decades, uncontrolled hemorrhage has become a major indicative factor. Causes such as uterine atony, ruptured uterus and placenta previa vary from one area to another, and are influenced by standards of practice and quality of antenatal care. 3,4 Although the operation is referred to as “ cesarian hysterectomy,” peripartum or obstetric hysterectomy is a better classification. A previous history of cesarian section (CS) increases the risk for hysterectomy by increasing the incidences of factors such as placenta previa/accreta and uterine rupture. 5,6 In this study, we reviewed all the available notes of obstetric hysterectomies (25 cases) performed at the Taif Maternity Hospital (TMH) between 1990 and 1998. We compared this with 25 cases of patients who had had at least their third CS operations during the data collection period. Our objective was to evaluate the sociodemographic distribution, risk factors, indications and outcome of emergency obstetric hysterectomy. Materials and Methods Twenty-five of 29 case notes of emergency obstetric hysterectomy cases were reviewed. Relevant data were extracted using a predesigned form. The 25 cases of CS performed during the data collection period were taken randomly and consecutively. The only inclusion criteria were that the patient should have had at least her third CS and had not had a previous hysterectomy. This group acted as a controlled group to compare the result with our study group. Statistical analysis, using two-tailed Student’s ttest, was applied. A consultant or an experienced specialist usually performed obstetric hysterectomy in our institution.