Clinical governance of hysterectomies in a rural tertiary health care centre

Sayali S. Alaspurkar; Poonam V. Shivkumar; Shuchi M. Jain; Shila P. Shelke

doi:10.18203/2320-1770.ijrcog20263994

Authors

Sayali S. Alaspurkar Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
Poonam V. Shivkumar Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
Shuchi M. Jain Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India
Shila P. Shelke Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263994

Keywords:

Abnormal uterine bleeding, Conservative management, Cross-sectional study, Hysterectomy, Leiomyoma, Oophorectomy, Rural health, Surgical determinants

Abstract

Background: Hysterectomy remains one of the most performed gynecological surgeries worldwide. Despite the availability of medical therapy and minimally invasive procedures, hysterectomy continues to be widely practiced, particularly among rural women. Understanding the clinical determinants influencing hysterectomy and evaluating the adequacy of prior conservative treatment is essential for improving gynaecological care. Objectives were to assess the clinical and sociodemographic factors influencing hysterectomy and to evaluate the provision and adequacy of conservative management prior to surgery in a rural tertiary care setting.

Methods: This hospital-based cross-sectional analytical study included 200 women who underwent hysterectomy at MGIMS Sewagram, Maharashtra during the study period. Data were obtained from medical records and included sociodemographic characteristics, presenting symptoms, uterine size, menopausal status, histopathological findings, type of hysterectomy, oophorectomy status, and prior conservative management.

Results: Most women were aged 40-50 years (66.0%) and multiparous (76.0%), with 91.0% residing in rural areas. Abnormal uterine bleeding was the most common presenting symptom (40.1%). Leiomyoma was the predominant histopathological finding (41.5%). Abdominal hysterectomy was the most frequently performed procedure (66.0%). Only 49.0% of women received conservative management prior to surgery, of whom just 18.0% received treatment for more than six months, indicating limited adequacy of medical therapy.

Conclusions: Hysterectomy in this rural population was performed for benign gynecological conditions, with inadequate utilisation of conservative treatment in many cases. Strengthening early diagnosis, ensuring adequate trials of medical therapy and expanding access to minimally invasive approaches may help reduce potentially avoidable hysterectomies.

References

Albright BB, Heyward QD, Erkanli A, Loehrer AP, Myers ER, Havrilesky LJ, et al. Geographic variation in the rate and route of hysterectomy for benign disease in the United States: a retrospective cross-sectional study. BJOG. 2023;130(12):1502.

Cohen SL, Ajao MO, Clark NV, Vitonis AF, Einarsson JI. Outpatient hysterectomy volume in the United States. Obstet Gynecol. 2017;130(1):130-7.

Moore BJ, Steiner CA, Davis PH, Stocks C, Barrett ML. Trends in hysterectomies and oophorectomies in hospital inpatient and ambulatory settings, 2005-2013. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006.

Hill EL, Graham ML, Shelley JM. Hysterectomy trends in Australia- between 2000/01 and 2004/05. Aust N Z J Obstet Gynaecol. 2010;50(2):153-8.

Lykke R, Blaakær J, Ottesen B, Gimbel H. Hysterectomy in Denmark 1977-2011: Changes in rate, indications, and hospitalization. Eur J Obstet Gynecol Reprod Biol. 2013;171(2):333-8.

Lauterbach R, Joseph M, Haklai Z, Gil L, Lowenstein L. Geographic variation of hysterectomy rates in the Israeli health care system during the years 2007-2016. Isr J Health Policy Res. 2019;8(1).

Hanstede MMF, Burger MJ, Timmermans A, Burger MPM. Regional and temporal variation in hysterectomy rates and surgical routes for benign diseases in the Netherlands. Acta Obstet Gynecol Scand. 2012;91(2):220-5.

Stoller N, Wertli MM, Zaugg TM, Haynes AG, Chiolero A, Rodondi N, et al. Regional variation of hysterectomy for benign uterine diseases in Switzerland. PLoS One. 2020;15(5).

Madhvani K, Curnow T, Carpenter T. Route of hysterectomy: a retrospective, cohort study in English NHS Hospitals from 2011 to 2017. BJOG. 2019;126(6):795-802.

Moosazadeh M, Asadi-Aliabadi M, Ghasemi Tirtashi M, Pejman M, Gheibi M, Ghadirzadeh E. Prevalence of hysterectomy and its determinants in northern Iran: enrollment results of the Tabari cohort study. BMC Womens Health. 2024;24(1):502.

Singh SK, Chauhan K, Tripathi V. Key drivers of hysterectomy among women of reproductive age in three states in India: comparative evidence from NFHS-4 and NFHS-5. BMC Womens Health. 2024;24(1):107.

Rout D, Sinha A, Palo SK, Kanungo S, Pati S. Prevalence and determinants of hysterectomy in India. Sci Rep. 2023;13(1):14569.

Santiago S, Richardson D, Kamdar N, Till SR, As-Sanie S, Hong CX. Association among surgeon volume, surgical approach, and uterine size for hysterectomy for benign indications. Obstet Gynecol. 2024;144(6):817-25.

Harlow SD, Hood MM, Mukwege A, Randolph JF, Gold EB, Elliott MR, et al. The relation of heavy or prolonged bleeding during the menopause transition to risk of hysterectomy. Women’s Health. 2025;21:17455057251351418.

Wankhade R, Dawande P. Histopathological analysis of hysterectomy specimens in a tertiary care centre: a retrospective study. Cureus. 2023;15(12):e50497.

Liao L, Chen L, Melamed A, Hershman DL, Wright JD. Use of conservative therapies before hysterectomy for uterine leiomyomas. Obstet Gynecol. 2023;141(2):371-4.