A retrospective analysis of obstetric hysterectomy in a tertiary center over one year

Authors

  • Sharvari A. Khandkar Department of Obstetrics and Gynecology, B. J. Medical College, Ahmedabad, Gujarat, India
  • Mahima Jain Department of Obstetrics and Gynecology, B. J. Medical College, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20234091

Keywords:

Morbidly adherent placenta, Obstetric hysterectomy, Postpartum hemorrhage, Previous caesarean section

Abstract

Background: Obstetric hysterectomy is a lifesaving procedure in a setting of life-threatening obstetrical hemorrhage. There is and increasing need of obstetric hysterectomy due to rising cases of caesarean sections and morbidly adherent placenta. We aimed to study the incidence, indications and fetomaternal outcome of obstetric hysterectomy. Various risk factors are discussed which may be helpful in reducing maternal and neonatal morbidity.

Methods: A one year hospital based retrospective study involving detailed medical records of patients who underwent obstetric hysterectomy between 1st April 2022 and 31st march 2023.

Results: The overall incidence of obstetric hysterectomy was 0.2% in this study with majority of patients in the 20-25-year age group, and patients who were 2nd and 3rd para comprised of the maximum number. The indication identified in this study were morbidly adherent placenta followed by atonic PPH and caesarean scar ectopic. The major risk factors noted were previous LSCS in 60% and morbidly adherent placenta in 53.3% patients. Of the 15 patients, 60% underwent total while 40% underwent subtotal hysterectomy. ICU admission, fever and coagulopathy were the leading post op complications. There was one case of maternal death noted and one case each of intrauterine death and perinatal mortality.

Conclusions: Obstetric hysterectomy is the last resort to intractable bleeding and hence an important lifesaving procedure. The feto-maternal outcome depends on timely decision, surgical techniques and stringent post op monitoring of these patients.

References

National library of medicine. Fact sheet: Oman Med J. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459165/. Accessed on 25 June 2023.

Zhang, Yulong MD; Yan, Jianying MD. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage-A 12-year review. Medi. 2017;96(45):e8443.

Mbakwa MR, Tendongfor N, Ngunyi YL, Ngek ES, Alemkia F, Egbe TO. Indications and outcomes of emergency obstetric hysterectomy; a 5-year review at the Bafoussam Regional Hospital, Cameroon. BMC Pregnan Child. 2021;21(1):323.

Kanhere A, Sapkal R. Obstetric hysterectomy: a retrospective study at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2013;2(4):562-5.

Gică N, Ragea C, Botezatu R, Peltecu G, Gică C, Panaitescu AM. Incidence of emergency peripartum hysterectomy in a tertiary Obstetrics Unit in Romania. Medic. 2022;58(1):111.

Dani A, Sabnis HB, Patil S, Gulati D. Emergency obstetric hysterectomy: A study from a tertiary teaching hospital. MedPulse Int J Gynaecol. 2020;13(2):43-7.

Kanwar M, Sood PL, Gupta KB. Emergency hysterectomy in obstetrics. J Obstet Gynecol India. 2003;53:350-2.

Siddiq N, Ghazi A, Jabbar S, Ali T. Emergency Obstetrical Hysterectomy (EOH): A Life saving procedure in obstetrics. Pak J Surg. 2007;23(3):217-9.

Devi P, Singh RK, Singh D. Emergency Obstetric hysterectomy. J Obstet Gynecol India. 2004;54:343- 5.

Vázquez JA, Rivera GV, Higareda SH, Páez FG, Vega CC, Segura AP. Obstetric hysterectomy. Incidence, indications and complications. Ginecol Obstet Mex. 2008;76(3):156-60.

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Published

2023-12-29

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Original Research Articles