Emergency obstetrical hysterectomy: frequency indications and maternal outcome

ABSTRACT

Obstetric hysterectomy still remains a necessary tool for the obstetrician. It is a life saving procedure in cases of severe hemorrhage. The aim of present study was to determine the frequency indication, associated risk factors, maternal morbidity and mortality associated with obstetric hysterectomy in tertiary care center, Lady Willingdon Hospital, Lahore. Retrospective descriptive study. Study carried out in the Department of Obstetrics and Gynecology, Lady Willigdon Hospital, Lahore from August 2005 - July 2010. The frequency of obstetric hysterectomy over a study period was 0.24%. One hundred and eighteen patients were identified. During the same period total 48000 deliveries were conducted. Majority of the women were in the age group 26-40 years, presented between 37-40 weeks of gestation and were mutiparas. Main indications were postpartum hemorrhage, placenta previa and ruptured uterus. Associated risk factors include previous caesarean delivery, placenta previa, multiparity, placental abruption and uterine atony. Complications included postoperative shocks, febrile illness, paralytic ileus, wound infection and urinary tract infection. All women require blood transfusions, total abdominal hysterectomy was commonly performed surgery in our study. Maternal mortality occurred in 13% of patients and due to septicemia, DIG, hypovolemic shock and pulmonary edema. Obstetric hysterectomy is a life saving procedure but decision should be prompt and treatment by an experienced surgeon. It is associated with significant maternal morbidity and mortality which can be prevented by community education about delivery by skilled birth attendants, good maternal care education, active management of labour, early recognition of complications, timely referral and easy availability of transport and third delay at referral facility