RESUMO
Background: Emergency obstetric hysterectomy is an unequivocal marker of severe maternal morbidity and, in many respects, the treatment of last resort for rupture uterus, severe postpartum hemorrhage (PPH) and other such life-threatening conditions. In no other gynaecological or obstetrical surgery is the surgeon in as much a dilemma as when deciding to resort to an emergency hysterectomy. On one hand it is the last resort to save a mother’s life, and on the other hand, the mother’s reproductive capability is sacrificed. This study is conducted with an aim to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency obstetric hysterectomy in a tertiary care centre.Methods: We conducted a prospective, observational, and analytical study over a period of two years, from September 2017 till September 2019. A total of 56 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, MKCG Medical College, Berhampur.Results: The incidence of EOH in our study was 12 following vaginal delivery and 44 following caesarean section. The overall incidence was 56 per 21,128 deliveries. Uterine rupture (37.5%) was the most common indication followed by atonic postpartum hemorrhage (25%) and placenta accrete spectrum (10.7%). The most frequent sequelae were febrile morbidity (25.7%) and disseminated intravascular coagulation (21.4%). Maternal mortality was 17.1% whereas perinatal mortality was 51.7%.Conclusions: A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of caesarean section and multiple pregnancies particularly in urban settings in developing countries.
RESUMO
Background: Obstetric hysterectomy is done as a lifesaving procedure in very trying circumstances of life threatening severe hemorrhage. The study was undertaken with the aim to evaluate the relative frequency of hysterectomy done for obstetric indication among the hysterectomy specimens and also to assess the histopathological findings in the hysterectomy specimens.Methods: The study was conducted at a tertiary care center over a period of two and half years. Consecutive specimens of hysterectomy done for obstetrical indication were included. Gross and microscopic findings noted and data analysed. The study was approved by the Institute Ethical Committee.Results: Of the total hysterectomy specimens received obstetrical hysterectomy comprised only 1.3%(12/915) of all the hysterectomies. Patient’s age ranged from 20-36 years; mean 28.6 years. Parity ranged from 1 to 5; mean 2. More multiparous women 91.7%(11/12) had hysterectomies as compared to primiparous 8.3%(1/12) cases (p value <0.0001). All patients had single pregnancy. All (100%) patients underwent surgery through abdominal route with subtotal hysterectomy with preservation of the bilateral adnexae undertaken in most (11/12; 91.7% cases). About 5(41.6%) cases hysterectomies were performed after previous caesarean section and had abnormal placentation. Histopathological examination revealed adherent placenta in 33.4%(4/12), endometritis in 25%(3/12), rupture in 25%(3/12) and histologically unremarkable in 16.6%(2/12) cases.Conclusions: Obstetric hysterectomy is an emergency lifesaving procedure done in situations of uncontrolled post-partum hemorrhage. In recent years with more number of caesarean sections the incidence of abnormal placentation has drastically increased, thus making adherent placenta as the most common histopathological finding.
RESUMO
Background: Obstetric hysterectomy remains a necessity in preventing maternal mortality in catastrophic rupture of the uterus or intractable postpartum hemorrhage when all the conservative management options fail. Uterine atony followed by abnormal placentation remains the primary indication of emergency obstratic hysterectomy worldwide. In majority of cases, anticipation, prompt resuscitation and earlier surgical intervention by skilled operator will reduce patient’s morbidity and mortality. The first successful operation was performed in 1876. The main objective of the study was to study frequency, indications and fetomaternal outcome of emergency obstetric hysterectomy in tertiary care center.Methods: Observational, retrospective and analytical study was done over 2 years from January 2017 to January 2019. A total of 11 cases of emergency obstretic hysterectomy (EOH) were recorded.Results: The overall incidence was 1.47 per 1000 deliveries. Atonic postpartum hemorrhage (54%) was the most common indication followed by placenta previa (18%) and placenta accreta (9%). Second gravida were mostly involved (45%) with previous LSCS (45%) as a common risk factor in commonest age group of 20-25 years (46%) amongst them. The most frequent squeal was disseminated intravascular coagulation (45%). Maternal mortality was nil while neonatal mortality being 9%. The decision of performing total or subtotal hysterectomy along with bilateral internal iliac ligation was influenced by patient’s condition.Conclusions: Emergency obstretic hysterectomy is the most demanding obstretic surgery performed in circumstances of life threatening hemorrhages where conservative surgical modalities fail and interventional radiology is not immediately available. Antenatal anticipation of the risk factors, involvement of experienced obstetrician at the early stage of management and prompt hystrectomy after adequate rescuitation will reduce fetomaternal mortality and morbidity.
RESUMO
Background: Obstetric hysterectomy was developed as a heroic operation arising out of necessity to control post-partum haemorrhage thereby reducing maternal mortality. The objectives of this study are to examine the incidence, indications, outcomes and complications of obstetric hysterectomy in a tertiary care hospital. It also aims to study the changing trends in incidence and indications in present day obstetric practice.Methods: This is a one-year study including 31 cases of obstetric hysterectomy performed in the Department of Obstetrics and Gynecology in a tertiary care hospital of Gujarat. Each case is analyzed, computed and tabulated as per standard proforma including clinical assessment, questionnaire, examination and investigations.Results: In present study 68% cases were in 21-30 years which is peak reproductive age. 55% patients were from rural areas and 52% cases were having three or more parity. The incidence of obstetric hysterectomy is 0.432% in both vaginal and cesarean deliveries i.e. 1 in 231 deliveries. Major indication for obstetric hysterectomy is morbidly adherent placenta 32% followed by atonic PPH 25.8% and ante partum hemorrhage in 22.58% due to increase in rate of cesarean sections. Most common complication is DIC and maternal mortality in around 16.12%.Conclusions: Obstetric hysterectomy is still a lifesaving surgery in modern day obstetrics. Quick decision for obstetric hysterectomy reduces maternal morbidity and mortality. Most of the morbidity is attributable to its indication and underlying disorder rather than the procedure itself.
RESUMO
BACKGROUND: The purpose of this study was to review incidence, indications, complications, and the anesthetic management of emergency obstetric hysterectomies. METHODS: This was a retrospective study of the cases of emergency obstetric hysterectomies performed at the Woman's Hospital over a 3 year period between January 2008 and December 2010. The indication for surgery, anesthetic management, operating time, estimated blood loss, pre- and postoperative hemoglobin and hematocrit values, need for blood transfusion, and perioperative complications were obtained. RESULTS: During the study period there were 46 emergency obstetric hysterectomies for 20147 deliveries, giving an incidence of 2.28/1000 deliveries. The number of emergency hysterectomies was significantly higher with the cesarean deliveries than with the vaginal deliveries. The most common indication for emergency obstetric hysterectomy was placenta accreta. Postoperatively, Dissemimated Intravascular Coagulation (DIC) was the most common complication. CONCLUSIONS: Abnormal placenta has been an main indication of emergency hysterectomy. Anesthesiologists should be eligible to aware of high risk of emergency hysterectomy and deal with massive hemorrhage.
Assuntos
Transfusão de Sangue , Emergências , Hematócrito , Hemoglobinas , Hemorragia , Histerectomia , Incidência , Período Periparto , Placenta , Placenta Acreta , Estudos RetrospectivosRESUMO
Emergency hysterectomy has been accepted as a life-saving procedure for patients with bleeding at the time of cesarean section. This study analyzed the patients of emergency obstetric hysterectomy performed at CHA hospital for 4 years from January 1990 to December 1993. During the 4 year study there were 32,090 deliveries, 8021 of which were cesarean sections. 42 emergency obstetric hysterectomies were performed; there were 36 cases after normal spontaneous vaginal delivery and 6 cases after cesarean section. The results of this study were as follows ; 1) 42 patients were evaluated, ranging in age from 23 years to 41 years and averaging 32 years. 2) The most common indications for cesarean hysterectomy were atony (35.7%) and placenta previa and accreta (35.7%). 3) Five patients received continuous epidural anesthesia and three of them with initially satisfactory epidural anesthesia required intraoperative induction of general anesthesia. Other patients received general anesthesia. Mean anesthetic time was 2 hours and 37 minutes. 4) Mean units transfused during operation were 11.1 pints. Mean preoperative hemoglobin and hematocrit were 10.3 g/dl and 31.9%. Mean postoperative hemoglobin and hematocrit were 10.5 g/dl and 33.1%. 5) Complications were found in 6 cases, including bladder injury, bleeding at the vaginal cuff area, pulmonary edema and paralytic ileus. Average hospital stay was 8.8 days.