Obstetric Hysterectomy a Life Saving Procedure and its Complication

Background:Previously in developing countries obstetric hysterectomy was done when conservative measures fail to control the post partum hemorrhage. Now a days because of increasing incidence of cesarean deliveries incidence of placenta praevia is increasing. This is contributing as a major cause for obstetrics hysterectomy.

Objective: The purpose of the present study was to determine the incidence, indications, complications, maternal morbidity and mortality associated with emergency obstetrics hysterectomy.

Methods: Retrospective study of cases undergone obstetric hysterectomy over a period of five years were done. Maternal age, parity, indication for obstetric hysterectomy, risk factors, type of operation performed, additional surgeries and complications were studied.

Results: The incidence of emergency obstetric hysterectomy in our study was 0.38% [15 in 3900 deliveries]. 73.3% of the women were above 26 years. 73.3% of patients belonged to parity four or above. Majority of the cases were unbooked (60%). Postpartum hemorrhage (40%), ruptured uterus (20%) and morbidly adherent placenta (20%) were the major indications for obstetric hysterectomy. Previous LSCS was a major risk factor as it is seen in 40% cases. In 66.7% cases total hysterectomy was performed. Fever was the most common complication seen in 26.6% cases. One (6.7%) patient had maternal mortality.

Conclusion: Proper antenatal care and early referral can prevent this catastrophic event. Moreover, timely decision, liberal blood transfusion and speedy surgery by an experienced surgeon are important in the management of this life saving procedure to avoid complications.