A retrospective study of obstetric hysterectomy cases at tertiary care centre
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20202714Keywords:
Maternal mortality, Morbidly adherent placenta, Obstetric hysterectomy, Postpartum haemorrhageAbstract
Background: Postpartum haemorrhage (PPH) is a life-threatening condition. The objective of this study was to determine the incidence, demographic characteristics, indications, and feto-maternal outcomes associated with obstetric hysterectomy in a tertiary care centre.
Methods: This is a retrospective analytical study conducted over a period of six years, from March 2014 to April 2020. A total of 68 cases of obstetric hysterectomy were studied at tertiary care centre in Ahmedabad, Gujarat, India.
Results: Present study reported 68 obstetric hysterectomies per 44663 total deliveries (incidence - 0.15%), out of them 20 following 26446 vaginal deliveries (0.07%) and 48 following 18217 caesarean section (0.26%). Morbidly adherent placenta (29.41%) was the most common indication followed by atonic postpartum haemorrhage (25.00%) and uterine rupture (17.64%). The most frequent sequelae were disseminated intravascular coagulation (26.47%) and febrile morbidity (10.29%), maternal mortality was 16.17% whereas neonatal mortality was 26.47%.
Conclusions: The incidence of obstetric hysterectomy has been found to be more following caesarean sections. There is a change in the indications of obstetric hysterectomy in the past two decades with placenta accreta spectrum being the commonest in present study. This is because of rising number of caesarean sections. Patients who underwent emergency obstetric hysterectomy due to atonic PPH had a higher mortality.
References
Say L, Souza JP, Pattinson RC. WHO working group on maternal mortality and morbidity classifications. Maternal near mis-towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287-96.
Shaikh N, Shaikh S, Shaikh J. Morbidity and mortality associated with obstetric hysterectomy. J Ayub Med Coll Abbottabad. 2010;22(2):100-1.
Amad SN, Mir IH. Emergency peripartum hysterectomy: experience at Apex Hospital of Kashmir Valley. Internet J Gynecol Obstet. 2007;8:2.
Barclay DL, Hawks BL, Frueh DM. Elective cesarean hysterectomy: a 5-year comparison with cesarean section. Am J Obstet Gynecol. 1976;124(8):900-11.
Stanco LM, Schrimmer DB, Paul RH, Mishell DR. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol. 1993;168(3):879-83.
Kastner ES, Fifueroa R, Garry D, Maulik D. Emergency peripartum hysterectomy: experience at a community teaching hospital. Obstet Gynecol. 2002;99:9715.
Zelop CM, Harlow BL, Frigoletto FD, Safon LE, Saltzman DH. Emergency peripartum hysterectomy. Am J Obstet Gynecol. 1993;168:14438.
Agrawal S, Yadav R, Raghunandan C, Dhingra S, Kaur H. Peripartum hysterectomy in a teaching hospital in India. Asian J Med Sci. 2013;4:5-9.
Korejo R, Nasir A, Yasmin H, Bhutta S. Emergency obstetric hysterectomy. J Pak Med Assoc. 2012;62:1322-5.
Kastner ES, Figueroa R, Garry D, Maulik D. Emergency peripartum hysterectomy: Experience at a community teaching hospital. Obstet Gynecol. 2002;99:971-5.
Kwee A, Bots ML, Visser GH, Bruinse HW. Emergency peripartum hysterectomy: a prospective study in the Netherlands. Eur J Obstet Gynecol Reprod Biol. 2006;124:187-92.
Sakse A, Weber T, Nickelsen C, Secher NJ. Peripartum hysterectomy in Denmark 1995-2004. Acta Obstet Gynecol Scand. 2007;86:1472-5.
Bateman BT, Mhyre JM, Callaghan WM, Kuklina EV. Peripartum hysterectomy in the United States: nationwide 14-year experience. Am J Obstet Gynecol. 2012;206(1):63.e1-63.e8.
Knight M, UKOSS . Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG. 2007;114(11):1380-7.
Korejo R, Nasir A, Yasmin H, Bhutta S. Emergency obstetric hysterectomy. J Pak Med Assoc. 2012.;62(12):1322-5.
Francois K, Ortiz J, Harris C, Foley MR, Elliott JP. Is peripartum hysterectomy more common in multiple gestations? Obstet Gynecol. 2005.;105(6):1369-72.
Walker MC, Murphy KE, Pan S, Yang Q, Wen SW. Adverse maternal outcomes in multifetal pregnancies. An Int J Obstet Gynaecol. 2004;111:1294-6.
Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol 2009. Jul;114(1):115-123. 10.1097/AOG.0b013e3181a81cdd
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33.
