Abstract
OBJECTIVES: To find out the frequency of obstetric hysterectomy, its indications and associated maternal complications in a tertiary care hospital of Lahore, Pakistan. METHODOLOGY: This is a retrospective observational descriptive study. It was done in Department of Obstetrics and Gynaecology of a Tertiary Care Hospital, Lahore from Feb 2015 to Jan 2016. All the records of patients, who had undergone hysterectomy, within 24 hours of normal delivery or caesarean section, were reviewed. The details of age, parity, booking status, indication and Complications of operation were recorded on a predesigned proforma. RESULTS: The total deliveries during the period were 5, 754. Obstetric hysterectomy was performed in 26 patients. This gives frequency of the emergency obstetric hysterectomy in our unit to be 4.5/1000 births. The major indication was previous caesarean sections with placenta previa and/or accreta in 17 cases (65.38%), followed by massive postpartum haemorrhage due to uterineatony in 4 cases (15.38%), uterine rupture in 3(11.5%) and abruption placenta in 2 (7.6%). Most common complication was haemorrhagic shock seen in 14 patients. There were 5 cases of bladder injury, 2 Ureteric injury and 2 vault hematomas. Maternal deaths occurred in 3 cases. CONCLUSION: Emergency obstetric hysterectomy is increasing with increased frequency of caesarean sections and placenta previa and accreta. Antenatal booking of high risk patients, timely referral to tertiary care hospital with good surgical expertise and ICU care can reduce morbidity and mortality in such cases.
Highlights
Obstetrical haemorrhage contributes to 80% of maternal mortality worldwide
The important risk factors which should be noted in history are high parity, number of previous cesarean section, previous abortions ending in curettage and previous myomectomy as these strongly increase the likelihood of placenta previa and abnormally adherent placenta
Obstetric hysterectomy being performed by an experienced surgeon is reported to significantly reduce the operating time, number of units of blood transfusion and operative complications
Summary
Obstetrical haemorrhage contributes to 80% of maternal mortality worldwide. Obstetric hysterectomy is removal of uterus during or immediately after abdominal or vaginal delivery to save maternal life.[1]. Uterine atony was the most common cause of obstetric hysterectomy in the past but with the increase in cesarean section rate placenta previa and placenta accreta has become more common indications. The important risk factors which should be noted in history are high parity, number of previous cesarean section, previous abortions ending in curettage and previous myomectomy as these strongly increase the likelihood of placenta previa and abnormally adherent placenta. These predisposing risk factors can be determined to a certain extent by performing antenatal ultrasound with color Doppler and magnetic resonance imaging (MRI). The purpose of our study was to determine frequency, indication and maternal morbidity and mortality associated with obstetric hysterectomy at our tertiary care hospital
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