Background: Obstetric hysterectomy is done as a lifesaving procedure in very trying circumstances of life threatening severe hemorrhage. The study was undertaken with the aim to evaluate the relative frequency of hysterectomy done for obstetric indication among the hysterectomy specimens and also to assess the histopathological findings in the hysterectomy specimens.Methods: The study was conducted at a tertiary care center over a period of two and half years. Consecutive specimens of hysterectomy done for obstetrical indication were included. Gross and microscopic findings noted and data analysed. The study was approved by the Institute Ethical Committee.Results: Of the total hysterectomy specimens received obstetrical hysterectomy comprised only 1.3%(12/915) of all the hysterectomies. Patient’s age ranged from 20-36 years; mean 28.6 years. Parity ranged from 1 to 5; mean 2. More multiparous women 91.7%(11/12) had hysterectomies as compared to primiparous 8.3%(1/12) cases                         (p value <0.0001). All patients had single pregnancy. All (100%) patients underwent surgery through abdominal route with subtotal hysterectomy with preservation of the bilateral adnexae undertaken in most (11/12; 91.7% cases). About 5(41.6%) cases hysterectomies were performed after previous caesarean section and had abnormal placentation. Histopathological examination revealed adherent placenta in 33.4%(4/12), endometritis in 25%(3/12), rupture in 25%(3/12) and histologically unremarkable in 16.6%(2/12) cases.Conclusions: Obstetric hysterectomy is an emergency lifesaving procedure done in situations of uncontrolled post-partum hemorrhage. In recent years with more number of caesarean sections the incidence of abnormal placentation has drastically increased, thus making adherent placenta as the most common histopathological finding.

Context:Uterine prolapse accounts for one of the common gynecological problems in India. The excised uterus is not expected to have any pathological finding other than atrophic endometrium and may be an ulcer because of the prolapse.Aims:The aim of this study is to assess the hysterectomy specimen for unsuspected pathology.Subjects and Methods:The study is done over two and half years at a tertiary care hospital. Hysterectomy specimens done with a clinical indication of prolapse were included in the study. Histopathological examination done, findings noted, and data analyzed.Statistical Analysis Used:Descriptive analysis was used in this study.Results:Of the total hysterectomy specimens, 55 (6%) were done for uterovaginal prolapse. Patients age ranged from 32 to 78 years; mean 51.1 ± 11.9 years. Majority (46; 83.6%) of the patients were above 40 years of age, whereas only (9; 16.4%) were < 40 years of age (P < 0.0001) Vaginal hysterectomy was done in most 38 (69.1%) cases as compared to abdominal hysterectomy in 17 (30.9%) cases (P < 0.001). Adnexae were removed in only 3 (5.5%) cases as compared to 52 (94.5%) cases, in which adnexae were preserved (P < 0.001). Chronic cervicitis was seen in 100% of cases. Majority (18:32.7%) of the endometrium was in atrophic phase, secretory in 8 (14.5%), cystic regressive hyperplasia and chronic endometritis in 4 (7.2%) each. Myometrium was unremarkable in 43 (79%) cases, whereas focal adenomyosis in 12 (21%) cases. All the adnexa received were histologically unremarkable.Conclusions:Grossly unremarkable specimens can have unsuspected histopathological lesion which could be potential premalignant or malignant lesions. Therefore, all hysterectomy specimens should be subjected to the histopathological examination for accurate diagnosis and proper categorization of lesions.

No abstract