Obstetric Hysterectomy Research Articles

A STUDY OF OBSTETRIC HYSTERECTOMY OVER A PERIOD OF 5 YEARS AT CUSMCH

Objectives: The study aimed (1) to determine the indication of obstetric hysterectomy and (2) to determine the fetomaternal outcome. Methods: This is a hospital-based retrospective study carried out in the Department of Obstetrics and Gynecology, C.U.Shah Medical College and Hospital from January 2018 to December 2020. Results: Out of 8881 deliveries during our study period, there were a total of 20 patients who underwent an obstetric hysterectomy, the incidence being 0.2%. Nine cases out of 6871 vaginal deliveries and 11 cases out of 2510 cesarean deliveries required an obstetric hysterectomy. Maximum patients, seven out of 20 were between 31 and 35 years age group followed by six patients between 36 and 40 years and five patients above 41 years. Only two patients were below 30 years of age. Most of the cases (70%) belonged to the lower middle class and 30% were from the upper middle class. About 60% were registered antenatal care (ANC) cases while 40% never visited any health-care facility. Out of 20 patients who underwent an obstetric hysterectomy, 18 patients (90%) were referred from another center while only 2 patients (10%) were admitted at our center. Eleven patients that are 55% delivered outside the institute among which three patients were home delivered by unskilled birth attendants. Nine patients were delivered at our center and among these sseven patients were referred from adjoining primary health-care centers, community health-care centers, and other private hospitals. Our institute being a tertiary hospital, maximum high-risk and complicated deliveries were referred. Conclusion: Obstetric hysterectomy is an unwanted but necessary emergency in obstetrics. It is a life-saving procedure in many catastrophic conditions, although it curtails the future. Good ANC, identification of risk factors, timely referral, and intervention at a well-equipped hospital can reduce obstetric hysterectomies. With the increasing incidence of cesarean deliveries and morbidly adherent placenta, the need for obstetric hysterectomy is increasing. With the improvement of modern obstetrics and modern modalities for the treatment of postpartum hemorrhage and adherent placenta, there is a reduction in the number of obstetric hysterectomies.

Prevalence of unexpected malignant disease in the histopathology of hysterectomy indicated for benign condition

To describe the prevalence of incidental malignant pathology following a hysterectomy performed for benign reasons. A descriptive cross-sectional study based on hospital records. Women who underwent hysterectomy for benign reasons at a general referral hospital between 2013 and 2021 were included. Women with obstetric hysterectomy were excluded. Measured variables: age, route of hysterectomy, type of hysterectomy, histopathological diagnosis of premalignant lesion or invasive cancer, type of cancer. Analysis: Descriptive, the prevalence of preneoplastic and neoplastic conditions was estimated for the overall period. Of 816 clinical records, 674 cases (87 %) met the inclusion criteria and were analyzed. The premenopausal population predominated. Twentysix cases of unexpected malignant disease were identified, yielding a prevalence of 3.8 %, and 13 cases of premalignant pathology (1.9 %). The most common origin was the cervix (40 %), followed by the ovary (33 %). Patients undergoing hysterectomy for benign conditions should be informed about the risk of unexpected injury. The importance of performing, in our context an adequate preoperative approach to rule out cervix uteri and ovarian cancer is emphasized. Follow-up studies of patients with unanticipated cancer are required to determine their treatment and prognosis in the region.

Emergency obstetrical hysterectomy among post-partum hemorrhage women in Larkana

Postpartum hemorrhage (PPH), is an excessive bleeding after giving birth, it is a major cause of maternal mortality and morbidity around the world. In the current era of obstetrics, emergency obstetric hysterectomy (EOH) is still a crucial treatment that can save lives. This study was designed to determine causes, frequency, complications of emergency cesarean /obstetrical hysterectomy in Postpartum hemorrhage (PPH) in tertiary care hospital. All the patients gave birth during 4 years (i.e. 1January 2020- 31 December 2023) were included in this study. The obstetrical patients admitted were 13532, out of which 154 underwent emergency hysterectomy. Their biodata, sign and symptoms, diagnosis, fluid/blood transfusion, morbidity, operative intervention, maternal mortality, and follow up were taken on a proforma. The data thus taken was compiled and analyzed. The incidence of EOH was 11.4/1000 obstetrical cases, mostly (85.5%) were referral from elsewhere, while 20 (13.79%) were registered as booked who took proper antenatal care. Multipara (94%) was predominantly reported with post-partum hemorrhage (n=79, 51.29%). The maternal mortality was 15.59% (n= 19). Regular and scheduled antenatal care, early diagnosis, early referral, timely decision, blood transfusion with arrangement of surgery by an experienced obstetrician are crucial to justify EOH.

Complications of placenta previa: A retrospective observational study at tertiary care hospital

: Placenta previa (PP) is condition where the placenta is inserted completely or partially into the lower uterine segment, at or after 28 weeks of gestation. Maternal and fetal risks are antepartum haemorrhage (APH), postpartum haemorrhage (PPH), abnormal adherence of placenta, low birth weight (LBW), intra uterine growth restriction (IUGR), preterm births and congenital malformations. The purpose of this study was to determine the proportion of placenta previa, the demographics of patients, types- severity, complications and the feto-maternal outcome in patients of placenta previa.: After due permission of Institutional Review Board, this retrospective observational study was carried out at tertiary care teaching hospital from July 2020 to November 2022.Proportion of pregnancies with placenta previa was 0.3%. Majority 44(91.7%) patients were registered, 38(79.2%) of patients were in age group of 21-30 years, 38(79.1%) patients were multigravida, 41 (85.4%) had major degree of placenta previa, 29(60.4%) patients admitted after 37 weeks of gestation and 47(97.9%) of patients were delivered by caesarean section. Majority of patients, 20 (41.7%) had mild anemia. Major complications were bleeding episodes during antenatal period/APH in 23 (47.9%) and PPH in 22 (45.8%) patients. Maternal mortality occurred in 1 (2.1%) patient. All babies were live at time of birth and 44(91.7%) babies were alive at the time of discharge and neonatal death occurred in 4 (8.3%) preterm babies (28-33 week gestation). Majority of patients were multigravida. No patient was severely anaemic. Majority of patients were delivered by CS. APH and PPH were major complications. About two third of patients required blood transfusion in ante/intra/post-natal period. Obstetric hysterectomy was required in about one tenth of patients. Majority of babies were alive at the time of discharge due to higher number of registered patients who took regular antenatal care, hospital delivery and good NICU facilities. Once diagnosed, placenta previa and morbidly adherent placenta should be managed at tertiary care centre with multidisciplinary approach so as to lessen the feto-maternal morbidity and mortality. Prevention is better than cure. Multiparity increases the risk of placenta previa. Hence, family planning with an aim to reduce unwanted pregnancies and abortions will help to reduce the chances placenta previa. CS increases the risk of development of placenta previa. Efforts should be made to reduce the primary caesarean section rate as it poses more risk of placenta previa, morbidly adherent placenta and its related complications in subsequent gestations.

Maternal And Fetal Outcome in Placenta Previa: A Multicenter Prospective Observational Study

Objective: To find out the frequency of placenta previa and maternal and fetal outcomes in cases of placenta previa in our population. Methods: All women with an age range from 18-40 years diagnosed with placenta previa based on ultrasound were recruited with the study. Data including patient age, parity, previous normal deliveries, previous caesarian sections, grade of the placenta previa and history of previous pregnancies was recorded. Maternal complications including post-partum haemorrhage, hysterectomy and death were also recorded. Fetal complications including low APGAR score at five minutes, low birth weight and death were also recorded. Results: The age group between 26-35 years seems to have the highest incidence of placenta previa (62.58%). Post-partum haemorrhage was seen in 57 (38.77%) patients. Post-partum haemorrhage was strongly associated with the grade of placenta previa. Emergency obstetric hysterectomy was done in 7 (4.76%) patients. Two (1.36%) patients died of complications. Out of 147, 38 (25.85%) had low APGAR scores, 52 (35.37%) had low birth weight and 12 (8.16%) died of various complications. Conclusion: Placenta previa has become a very common condition which may be attributable to higher rates of caesarians. It may lead to increased morbidity and mortality of the mother and the baby if not diagnosed and managed properly. These cases should be managed by experienced multidisciplinary teams in a tertiary care centre to minimize the rate of complications. Keywords: APGAR score, Intrauterine growth retardation,Neonatal, Placenta previa, Postpartum haemorrhage

Maternal Outcome of Emergency Obstetrics Hysterectomy

Maternal Outcome of Emergency Obstetrics Hysterectomy

Surgical Strategies in Placenta Accreta Spectrum; A Quasi-experimental study

Objective: To evaluate maternal outcome in placenta accrete spectrum with bilateral internal iliac artery ligation before and after obstetric hysterectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Oct 2022 to Sep 2023. Methodology: Seventy patients enrolled in the study underwent peripartum hysterectomy. Bilateral Internal Iliac Ligation was performed before obstetrical hysterectomy in 40 patients of Group -1, whereas it was done after hysterectomy in 37 patients of Group-2. In all cases, the baby was delivered via classical caesarean section, with the placenta left in situ, followed by the closure of the uterine incision. The number of blood transfusions, Intensive care unit stay, post-operative haemoglobin level, post- operative recovery events, and duration of hospital stay, along with demographic details, were noted. Results: Out of 77 patients, the mean age of patients was 28.79±3.05. Most patients (n=36, 46.8%) had the previous three scars. Fifty-four cases (70.1%) had bladder injury involving mucosa. 22(28.6%) females had post- operative haemoglobin ≤7g/dl. Our study revealed statistically significant differences in the type of bladder injury (p=0.024) and post- operative severe anaemia, i.e. Hb≤7g/dl (p=0.006) among the two groups. Conclusion: Bilateral internal iliac artery ligation prior to obstetrical hysterectomy leads to a reduction in post-operative severe anaemia and mucosal involvement in bladder injury.

Bilateral Internal Iliac Artery Ligation and its Role in Reducing Maternal Mortality

Background: Post-partum hemorrhage (PPH) is a common complication, seen following 2-4% vaginal deliveries and 6% of caesarean sections. 35% of maternal mortality worldwide (1) and 38% of maternal mortality in India can be attributed to PPH. Material and Methods: Women who had B/L IIAL over a period of 1year 2021 at Dr. VVP Pravara Rural Hospital, Loni were reviewed retrospectively. Patients were identified using hospital records and operation theatre registers. Clinical history, routine blood investigations, patient demographic data including age, parity, mode of delivery and surgical outcome with complications of procedure were noted. Results: A total of 30 PPH deliveries were conducted during the year 2021. most common indication for B/L IIAL was PPH, seen in 26 out of 30 cases (86.6%) followed by 3 cases of placenta accreta spectrum (1%) and 1 (0.3%) with gynecological complication. Of the 30 cases requiring B/L internal iliac ligation, 9 (30%) were primigravida, 3 (10%) second gravida and 18 (60%) multiparas with 2 or more prior deliveries. Of the 5 cases further requiring obstetric hysterectomy, 2 were second gravidas and 2 multiparas. Conclusion: The ligation of the internal iliac artery as a procedure to stop pelvic hemorrhage is not practiced as commonly as it should be. However, it is safe and effective method to control massive pelvic hemorrhage in experienced hands.

Uterine Rupture: A Distressing Catalyst for Severe Postpartum Hemorrhage

Uterine rupture is a disruption of the uterine scar, causing foetal expulsion into the peritoneal cavity. This condition, primarily caused by the separation of uterine scar tissue from previous caesarean surgery, reduces foetal survival and increases maternal morbidity and mortality. A 32-year-old woman with a history of four vaginal deliveries and one caesarean section was diagnosed with uterine rupture, leading to a laparotomy procedure and obstetric hysterectomy. Consistent antenatal care can prevent uterine rupture.

INEVITABLE MYOMECTOMY OF EXTRUDING INTRAMURAL FIBROID DURING CAESAREAN SECTION- A CASE REPORT

Myomectomy during caesarean sections have been avoided routinely in the past in the fear of massive hemorrhagewhich may lead to obstetric hysterectomy. However in the recent times with adequate facilities and expertise, caesarean myomectomies are being performed with good outcomes. Case Presentation: A35-year-oldprimi gravida was diagnosed to have intramural fibroid - anterior 4.6*4.3cm and posterior 1.8cm*2.8cm at 8 weeks of gestation.By 13 weeks, during her NT scan there was increase in the size of anterior wall fibroid 7.0*6.6cm, the rest of NT scan and first trimester screening was normal. She developed early onset intrauterine growth restriction in her anomaly scan. She was conservatively managed as the doppler flow was normal. Her scan at 36 weeks showed estimated fetal weight at 2nd centile with normal doppler flow in breech presentation and an anterior intramural fibroid of size 9.5*8.2cm.Hence an elective caesarean section was planned at 37 weeks.Baby was delivered by breech extraction. Manual removal of placenta was done. As the uterus started contracting, the intramural fibroid started extruding, became submucosal and bulging into uterine edges. Hence planned for myomectomy. Injection vasopressin was injected into the surface of myoma,enucleation of the myoma done and myoma bed closed in 2 layers followed by the closure of uterine edges. Intra operative blood loss was around 800ml. No primary or secondary PPH noted. Patient was discharged on 5th post operative day without any complaints. Conclusions: Routine myomectomy at the time of cesarean section is not a standard procedure worldwide. However, it may be considered in carefully selected patients in centers with good facilities to tackle complications by the experienced obstetricians.

769 Rationalization of obstetric hysterectomy trays: A quality-improvement initiative

769 Rationalization of obstetric hysterectomy trays: A quality-improvement initiative

Emergency Obstetric Hysterectomy in a Low Resources Country: An Eight-Year Retrospective Cohort Study from a Secondary Care Hospital in Niger

Emergency Obstetric Hysterectomy in a Low Resources Country: An Eight-Year Retrospective Cohort Study from a Secondary Care Hospital in Niger

Emergency obstetric hysterectomy: A retrospective analysis

Emergency obstetric hysterectomy: A retrospective analysis

A COMPARATIVE ANALYTICAL STUDY OF MATERNAL MORBIDITY AND MORTALITY INDICATORS BETWEEN PLACENTA ACCRETA SPECTRUM (PAS) AND NORMAL PLACENTATION DURING CAESAREAN SECTION

Introduction: The Placenta Accreta Spectrum (PAS) has emerged as a complex and increasingly prevalent condition, presenting formidable challenges in the field of obstetrics. PAS refers to a range of pathological conditions characterized by abnormal placental attachment to the uterine wall, leading to potentially life-threatening complications during pregnancy and childbirth. This condition has garnered significant attention from researchers, clinicians, and healthcare providers due to its rising incidence and the critical management decisions it demands. Methods: This was a Case-Control study which was conducted at the department of Obstetrics and Gynecology in a tertiary care referral center in Akola, India between January 2020, and June 2021, over a period of 18 months (about 1 and a half years). Sample size calculation were considered based on the incidence of Placenta Accreta Spectrum as outlined by the study done by Wu S et al [4]. Result: As noted by earlier studies, our study also found an increase in the overall morbidity of the patients of Placenta Accreta Spectrum disorders over patients with normal placentation, during and after caesarean section. Conclusion: Placenta Accreta Spectrum leads to significant maternal morbidity and mortality compared to normal placentation at caesarean section, as established by and increased rate of Obstetric Hysterectomies, longer operating times, increased need for blood and blood products, longer ICU stay, and increased rates of postpartum fever.

S. Rao Spiral Suturing (SRSS) of Lower Uterine Segment: An Innovative Hemostatic Technique in the Management of Placenta Previa and Accreta Spectrum.

The study aimed to demonstrate the efficacy and safety of an innovative hemostatic technique in managing Placenta Previa and Accreta Spectrum by S. Rao Spiral Suturing (SRSS) of a lower uterine segment. In this retrospective study conducted at Department of Obstetrics & Gynecology Unit-II of Nishtar Medical University, Multan between December 2018 to January 2021, one hundred and thirty consenting patients' clinical records were reviewed with major degree placenta previa/placenta accrete spectrum, either operated electively or presented in an emergency, with or without a history of previous cesarean section. The enrolled patients underwent SRSS, procedure's efficacy and safety were measured by the number of obstetrical hysterectomies, the time required for the procedure, estimated blood loss, blood transfusion volume, need for any other hemostatic technique, bladder trauma, pelvic infection, scar site hematoma or abscess, sepsis, duration of hospital stay and maternal mortality. Out of 130 patients, 17(12.6%) had Placenta Accreta, 86(66.3%) Increta, and 27(21%) Percreta. The Placenta location was anterior dominant in 102(78.4%) cases and posterior in 17(8.4%). Of the patients who underwent surgery, only two required obstetrical hysterectomy due to uncontrolled bleeding. The procedure took three to five minutes in 127 patients and five to seven minutes in three patients. Regarding intraoperative blood transfusion, 54.6% of patients were transfused 1000-2000 ml blood, and 5.38% required > 3000 ml. No blood transfusion was required postoperatively in any patient. Postpartum hemorrhage, infection, fever, and sepsis were not observed in any patient postoperatively. None of the patients suffered bladder injury. All patients were discharged as per routine. SRSS is an innovative, safe, effective, and simple suturing technique for patients with Placenta Previa and Accreta spectrum.

Non-pneumatic anti-shock garment (NASG) and balloon tamponade decrease maternal mortality and morbidity from Obstetrics Haemorrhage: A prospective observational study

Obstetric haemorrhage is the leading cause of maternal mortality and morbidity worldwide. A prospective observational study was conducted among 132 women admitted, booked/referred, at tertiary care centre with Obstetric Haemorrhage for 2 years period. Of these 71 patients had received Non-pneumatic antishock garment and / or Uterine Balloon Tamponade (Group 1) and 61 didn’t receive any (Group 2). Both groups were observed for its outcome. The socio-demographic parameters and obstetric characteristics among both groups were comparable. However, there were differences in their outcomes and complications. Surgical interventions were more among group 2 as compared to group 1, B-lynch/Modified B-lynch (8.4% vs. 1.6%), Stepwise devascularisation (2.8% vs. 1.6%) and Obstetric hysterectomy (7.0% vs. 3.2%). There was significantly more blood loss in Group 2 than group 1. Duration of hospital stay was significantly shorter (9.8±2.7 days) in Group 1 as compared to Group 2 (12.7±3.6). The shock index after intervention was significantly smaller (0.7±0.1) in Group 1 in comparison to Group 2 (0.8±0.1) and Group 1 required significantly less number of blood and blood products as compared to group 2. 19.7% required ICU admission in group 1 and 24.6% in Group 2. There was no mortality in group 1 and 3 patients died in group 2. NASG and UBT is both life-saving and cost effective and can become the first defence against Obstetric Haemorrhage.

Morbidly Adherent Placenta at Upper Segment of Uterus- A Case Report

Background: Morbidly adherent placenta (MAP) is a spectrum of disorder which describes adherence of all or part of the placenta to the uterine wall or surrounding organs. It is one of the most devastating complication of pregnancy. It occurs when there is abnormally firm attachment of placental villi to the uterine wall with the absence of normal intervening decidua basalis and nitabuch’s layer. MAP is often asymptomatic antenatally and the diagnosis is only established after unsuccessful attempt to remove of the placenta at delivery. A majority of morbidly adherent placenta are diagnosed during the third stage of labour or during caesarean section which results in adverse consequences including exsanguinating haemorrhage . It is one of the most common cause of obstetric hysterectomy. Accurate prenatal diagnosis is critical to reduce the risk of maternal morbidity and mortality.
 Aim: To report the case of a morbid adherent placenta at upper segment of uterus with conservation of uterus following reconstructive surgery.
 Case Presentation: A 24 years old 3rd gravid women with morbid adherent placenta at upper segment was treated by segmental resection and reconstructive surgery. Her post- operative period was uneventful.
 Conclusion: Antenatal diagnosis of morbidly adherent placenta, multi-disciplinary team with surgical expertise and facilities for blood transfusion can reduce maternal mortality and morbidity. This rare morbid attachment of placenta at upper segment is one of the example.
 Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 157-161

Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India.

The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India. Retrospective observational and comparative study from single rural tertiary care referral center of western India. A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH. Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% (p 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% (p 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%(p < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%(p < 0.001) and morbidly adherent placenta increases from 7 to 23%(p 0.007). ICU admission and ventilator support increases from 54 to 79%(p 0.04) and 22% to 70% (p < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% (p 0.5). Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.

A Retrospective Analysis of Emergency Obstetric Hysterectomy: A Life-Saving Intervention.

Introduction Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that plays a critical role in managing life-threatening obstetric emergencies. In our study, we sought to evaluate the incidence, indications, risk factors and maternal as well as fetal outcomes associated with EOH. Also, the study was conducted to review the operative experiences and trend of emergency hysterectomies done for various indications over a period of two years in our tertiary care center. Methods The present hospital-based retrospective analytical study was conducted in the Department of Obstetrics and Gynecology, L.L.R.M. Medical College, Meerut, between March 2021 to February 2023. All women who delivered within or outside the institute undergoing obstetric hysterectomy were included in our study. Out of a total of 7743 deliveries, 46 EOHcases were found. The data of these 46 EOH deliveries were collected and analyzedafter issuing ethical clearance by the Institutional Ethical Committee of L.L.R.M. Medical College, Meerut. Results During the two-year study period, 46 EOH were performed out of 7743 deliveries making an incidence of 0.504 EOH per 100 deliveries. Most of the cases were of multiparous women in the age group of 25 to 35 years (78%). The majority, 43.5% cases belonged to placenta accreta spectrum (PAS), followed by ruptured uterus (30.5%) and postpartum hemorrhage (PPH) (26%). The most frequent preoperative complication seen in EOH was severe anemia (29, 63%). Intraoperative bladder injury was seen in four cases, along with one case of ureteric injury. Postoperatively, cases were shown to have acute hemorrhagic shock (54.3%), disseminated intravascular coagulation (DIC), septicemia, wound infection, acute renal failure (ARF), hepatic encephalopathy and psychosis. Four maternal mortalities were observed in our study. Conclusion EOH is a necessary operative procedure in many obstetric emergencies including PAS and PPH. Despite intra-operative risk and possible postoperative complications, it remains a potentially life-saving procedure. Thus various surgeries for PAS and PPH should be the integral part of postgraduate trainings to save the lives of mothers and to reduce the maternal mortality.

Depression in young women after hysterectomy: Emergency obstetric versus elective procedure – A comparative cross-sectional study

Emergency obstetric hysterectomy (EOH) is done during cesarean section or after normal vaginal delivery, or any time during puerperal period. Puerperal period is usually associated with anxiety and depression in most cases, having emergency hysterectomy can potentially trigger it more. Therefore, this study was conducted to compare emergency versus elective hysterectomy to determine the pattern of depression between two groups. During a period of four years (from 1st march 2019 to 28th February 2023), a total of 6658 patients were admitted in obstetrics &amp; gynecology department and 31 underwent emergency obstetric hysterectomies and consented to be part of this study. These females were aged between 18 to 49 years. For comparison 31 married control females were randomly selected and interviewed 3 months after undergoing elective hysterectomy due to gynecological conditions. There was no past family history for any psychiatric illness in both groups. The studied groups were clinically evaluated for major depressive episode according to the American Psychiatric Association diagnostic and statistical Manual of mental disorders, 4th edition text revised (DSM-IV TR) criteria. Beck depression inventory (BDI)18 to assess the severity of major depressive episodes. Out of 31 patients 16 cases were performed after caesarean section, four during laparotomy for ruptured uterus and 11 for uterine atony after normal vaginal delivery. There was significantly higher rate of depression among patients undergoing emergency hysterectomy as compared to those with elective procedure. The frequency of complications was also observed to be higher in emergency cases. Our study concluded that the frequency of complications and severe depression was remarkably higher in the obstetric emergency hysterectomy group as compared to the elective hysterectomy group.