audit of obstetrical hysterectomy

ABSTRACT

Analysis of all obstetrical hysterectomies, performed in hospital during one year period, to find out its rate of incidence and indications Design: All obstetrical hysterectomies during one year period were studied. Clinical details, operative findings, postoperative complications and specific data leading to obstetrical hysterectomy was evaluated. Place and Duration of Study A prospective study was done from January 1995 to December 1995 in obstetrics and gynaecology unit 'B' of Postgraduate Medical Institute-Lady Reading Hospital, Peshawar. Subjects and The study was conducted on eighty-eight patients undergoing hysterectomy in the obstetric and gynaecology unit of Lady Reading Hospital, Peshawar. Record of all the patients was analyzed. Out of a total 7647 obstetric admissions. Out of these 2940 patients delivered. This included 439 [14.39%] caesarean sections. 88 [2.9%] patients had emergency obstetric hysterectomies. Incidence was 1 in 33 deliveries. All hysterectomies were performed as lifesaving procedures mainly due to ruptured uterus [54.5%], uncontrollable hemorrhage due to atonic uterus [27.27%], laceration [7.9%], and placenta increta [5.6%]. Other indications included placenta previa, placenta percreta, infected septic uterus and fibroid in the lower segment. Subtotal abdominal hysterectomies were done in 78 [88.6%] patients while 10 patients [11.36%] had total abdominal hysterectomies. Despite multiple pre-operative obstetric complications 73 patients recovered completely while 15 maternal deaths occurred [17.04%]. Of these 9 were considered inevitable because of delay in being transferred to hospital while 6 were unexpected and were considered preventable. Bilateral ligation of internal iliac artery was performed in 18 patients. Postoperative morbidity occurred in 67.0%. The high incidence of obstetrical hysterectomies indicate the lack of knowledge and negligence among population about pregnancy and child birth. Adequate education of primary health providers, traditional birth attendants and early referral is essential to reduce this condition