Emergency obstetric hysterectomy

ABSTRACT

In all 12.401 patients were delivered and 21 emergency obstetric hysterectomies were performed over a period of 6 years [1990-95] giving a frequency of 1.69/1000 deliveries. This drastic surgery was carried out to save valuable maternal lives in conditions of uncontrollable haemorrhage due to uterine rupture, atony, placenta praevia/accreta or disseminated intravascular coagulation [DIC]. Most of the patients were from the suburbs, unbooked, poor and lower middle class, 35-40 years of age, 52% with high parity, and 66.6% handled by traditional birth attendants [TBA], brought in moribund condition. They were resuscitated and given blood transfusions. Conservative methods were tried where possible; 15 underwent total and 6 subtotal hysterectomy. There were 5 maternal and 9 perinatal deaths. Ignorance, illiteracy, poverty, high parity, inadequate maternity and family planning services, lack of proper training of TBAs and transportation facilities predisposed to catastrophic conditions, adverse complications, grave morbidity, poor prognosis and maternal loss