Frequency, Indications and Maternal Outcome in Obstetric Hysterectomy in a Tertiary Care Centre in India.

ABSTRACT

The aim of present study is to review the frequency, indications, associated risk factors, maternal morbidity, maternal and fetal mortality associated with emergency obstetric hysterectomy in a tertiary care academic referral centre. A retrospective descriptive analysis from Jul 2005 to Jun 2010 was carried out in a tertiary care academic referral centre. Main outcome measures were frequency, indications, associated risk factors, maternal morbidity, maternal and fetal mortality associated with emergency obstetric hysterectomy. There were 41 cases of obstetric hysterectomy over the study period and the frequency of obstetric hysterectomy was 22.9/10,000 births. The incidence of hysterectomy for vaginal delivery was 0.017% and for caesarean section was 0.318%. Maximum number of patients (36.5%) were in the age group 26-30 years. 60.9% patients were antenatally unbooked emergency cases. It was most common in para two (46.3%) followed by para four or more (26.8). Main indications for obstetric hysterectomy were rupture uterus and postpartum haemorrhage (31.7% each) followed by morbidly adherent placenta (21.9%). All women required blood transfusion, 26 (63.42%) were anaemic, 5 (12.19%) required ICU stay. There was one maternal mortality and varied morbidity pattern. 12 fetal mortalities were noted, including 9 for uterine rupture, 2 for placenta previa in scarred uterus and one in obstructed labor case. Emergency obstetric hysterectomy still remains a life saving procedure and complications can be minimized by timely and thoughtful decision. Unnecessary delay or undue haste increase maternal morbidity.