Obstetric hysterectomy in a tertiary centre: a 3-year retrospective study

Mayuri V. More; Nandan S. Purandare; Aditi P. Kaundinya; Deeksha S. Poojari; Sudharani Gandi; Aloukika P. Patil; Sriram Gopal

doi:10.18203/2320-1770.ijrcog20231570

Authors

Mayuri V. More Department of Obstetrics and Gynecology, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India https://orcid.org/0000-0003-3380-2168
Nandan S. Purandare Department of Obstetrics and Gynecology, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India https://orcid.org/0009-0000-5813-0826
Aditi P. Kaundinya Department of Obstetrics and Gynecology, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India https://orcid.org/0009-0006-5110-3327
Deeksha S. Poojari Department of Obstetrics and Gynecology, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India https://orcid.org/0009-0008-2197-3828
Sudharani Gandi Department of Obstetrics and Gynecology, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
Aloukika P. Patil Department of Medical Sciences, Krishna Viswa Vidyapeeth, Karad, Maharashtra, India https://orcid.org/0009-0001-3653-2944
Sriram Gopal Department of Obstetrics and Gynecology, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India https://orcid.org/0000-0001-8671-3375

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231570

Keywords:

Caesarean hysterectomy, Adherent placenta, Atonic uterus, Obstetric hysterectomy, Obstetric emergencies

Abstract

Background: Obstetric hysterectomy (OH) is a life-saving procedure and involves removal of uterus in cases of intractable hemorrhage. This study includes 21 cases of OH in a period of 3 years at a tertiary centre. We sought to understand the prevalence, indications and outcomes of emergency obstetric hysterectomy.

Methods: This is a retrospective, observational study, conducted with the means of hospital delivery records in a tertiary care centre in Navi Mumbai. We included all patients who underwent obstetric hysterectomy in a span of 3 years between 1^st April 2020 to 31^st March 2023, in Dr. D.Y. Patil Hospital, Navi Mumbai, India.

Results: Twenty- one OH were done in the period of study. The incidence of obstetric hysterectomy was 0.45% (452 OH per 100,000 deliveries). It was more prevalent in patients with caesarean section compared to vaginal delivery. Women between the age 25-35 years group comprised of 57.15% cases. Out of the 21 women in the study 7 women were primigravida (33.33%). Most common cause for OH was observed to be uterine atony (42.85%) followed by adherent placenta (28.57%). Maternal morbidity like admission to intensive care unit and need for blood and blood product transfusion was noted in most patients, mortality was observed in only 1 case. Neonatal mortality was nil in this study but, admission to neonatal intensive care unit was required in 7 patients.

Conclusions: Although, obstetric hysterectomy kills the future reproductive prospect for a woman, it is life saving for her. Timely decision for OH can not only prevent mortality but, also morbidity for the woman. Previous caesarean section and multigravida have higher incidence of OH. Atonicity is the predominant cause for obstetric hysterectomy in this study.

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References

Kamble SN, Jamdade YM. Obstetric hysterectomy: a retrospective study. Int J Reprod Contraceptive Obstet Gynecol. 2021;10(12):4522-6.

Sturdee D, Rushton D. Caesarian and postpartum hysterectomy 1968-1983. Br J Obstet Gynaecol. 1986;93(3):270-4.

Shahid R, Abbas H, Mumtaz S, Bari MF, Ahmed N, Memon S, et al. Emergency obstetric hysterectomy, the histopathological perspective: a cross-sectional study from a tertiary care hospital. Cureus. 2020;12(7):e9094.

Chawla J, Arora CD, Paul M, Ajmani SN. Emergency obstetric hysterectomy: a retrospective study from a teaching hospital in North India over eight years. Oman Med J. 2015;30(3):181-6.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet. 2014;2(6):e323-33.

United Nation. Sustainable development goals. Take Action for the Sustainable Development Goals, 2019. Available at: http://www.un.org/sustainabledevelopment/sustainable-development-goals/2018. Accessed 10 February 2023.

Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462-74.

Say L, Souza JP, Pattinson RC. The WHO working group on maternal mortality and morbidity classifications, maternal near-miss-towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287-96.

Angelini CR, Pacagnella RC, Parpinelli MA, Silveira C, Andreucci CB, Ferreira EC, et al. Quality of life after an episode of severe maternal morbidity: evidence from a cohort study in Brazil. BioMed Res Int. 2018;2018:10.

Pukhrambam GD, Singh OO, Sarangthem B, Gauhar KU. Histomorphological study of the uterus in 64 peripartum hysterectomy specimens. Int J Med Biomed Studies. 2020;4:82-4.

Miller S, prevention and treatment of postpartum haemorrhage, new advances for low resource settings. J Midwifery Womens Health. 2004;49(4):283-92.

Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF, Maternal Health Study Group of the Canadian perinatal surveillance system investigation of an increase in postpartum haemorrhage in Canada. BJOG. 2007;114(6):751-9.

Sinha H, Mishra M. Hysterectomy for obstetric emergency. J Obstet Gynecol India. 2001;51:111-4.

Mantri L, Maheshwari K, Chandra. Emergency hysterectomy A ten years review. J Obstet Gynecol India. 1995;43:936-39.

Allahabadia G, Vaidya P. Obstetric hysterectomy (A review of 50 cases from January 1987 to August 1990). J Obstet Gynecol India. 1991;41:634-7.