EMERGENCY OBSTETRIC HYSTERECTOMY FREQUENCY AND MATERNAL OUTCOME

Emergency Obstetric Hysterectomy

Abstract

Objective: To review the frequency, indications and maternal outcome of emergency obstetric hysterectomy.
Study Design: Descriptive study
Place and Duration of Study: In obstetrics and gynecology department of Nawabshah Medical College Hospital Sindh from 2nd May 2005 to 31st April 2008.
Patients and Methods: During the study period total 3089 patients were delivered. Out of these, 37 patients underwent cesarean hysterectomy. Records of all the patients were analyzed. The parameter analyzed were age, parity, social status, booking status, indication for operation, operative notes, maternal outcome, complications and postoperative status. Mortality register was also checked for the causes of maternal deaths.
Results: During the study period, there were 3089 deliveries. Amongst these 37 had emergency obstetric hysterectomies giving rise to a frequency of 11.9 /1000 cases. Regarding parity, 23(62.1%) were multiparous, 12 (32.4%) patients were grand multiparous and 2(5.4%) patients were primiparous. Commonest indication of emergency obstetric hysterectomy was postpartum hemorrhage due to uterine atony which was seen in 13(35.1%) cases, followed by ruptured uterus in 11(29.7%) cases, placenta previa in 6(16.2%) cases, and couveliar uterus in 5 (13.5%) cases and placenta accreta in 2 (5.4%) cases. Commonest maternal complications were urinary tract infection in 6(16.2%) patients followed by DIC in 5(13.5%) patients. Maternal mortality was seen in 2 (5.4%) patients.
Conclusion: In our study frequency of emergency obstetric hysterectomy was high. Most common indication was rupture uterus, post partum hemorrhage due to atony uterus and placental causes. After UTI, disseminated intravascular coagulation was most common complication seen. 2 patients were expired.
Sever Emergency obstetric hysterectomy when performed in selected cases at an appropriate time helps in bringing down maternal mortality.