Risk Factors, Indications and Outcome of Emergency Obstetric Hysterectomy: A study performed at Tertiary Care Hospital

Abstract

Background: Emergency obstetric hysterectomy is the life-saving surgical intervention when all other available measures are unable to control obstetric hemorrhage. In addition to the known indications and risk factors for globally increasing this near miss event, home deliveries by untrained birth attendants is irrefutable cause of obstetric morbidity and mortality Aim: To identify the risk factors and indications for EOH like Pakistan. Study design: Retrospective descriptive study. Settings: OB/GYN department of Lahore General Hospital, PGMI. Duration: Two years, from start of 2020 to the end of 2021. Methodology: All patients having emergency obstetric hysterectomy in Gynae Unit 3, were included in this study. Risk factors and indications for the procedure were recorded. Outcome in the form of morbidity and mortality was reviewed. Results: Out of total 6809 deliveries, 48 patients had EOH and majority were multiparous with age ranging from 20 to 35 years. Complicated home deliveries ending in EOH were 8.32% of the cases. Two third of the patients had one or more previous caesarean sections and 70.8% underwent Caesarean section in the index pregnancy. Most of the women, 81.25%, were un-booked cases. Most common indication for EOH (50%) in our study was uterine atony and 45.81% of the cases had morbidly adherent placenta. Conclusion: Rising trend of caesarian sections leading to placental issues, lack of proper antenatal care and deliveries at inappropriate places are the contributing factors in morbidity and mortality associated with EOH. Keywords: Uterine atony, morbidly adherent placenta, emergency obstetric hysterectomy.

Indications and outcome of emergency obstetrics hysterectomy in last 5 years at ACPM medical college Dhule

“…While Dani A et al 3 found that 84.6% of patients had a history of multiparity. Similar results were seen in a study done by Aslam L. et al 5 reported that 79.16% were multipara in their study. The majority (88%) of the patients have registered ANC cases while the remaining 12% were unbooked & were referred late from the peripheral health care centers.…”

“…In our study, we found an incidence of 8 per 1000 deliveries. Similar results were reported in a study conducted by Aslam L. et al 5 7.05 per 1000 deliveries. While results in our study are in contrast with studies conducted by Dogra A. et al 1 it was 1.32 per 1000 deliveries, also Rana S. et al 2 reported 0.2 per 1000 deliveries.…”

“…A study conducted by Dani A. et al 3 reported that 69.2% of the patients had a history of previous LSCS flowed by 53.84% with APH. Similarly, a study done by Aslam L. et al 5 reported a 66.6% prevalence of previous LSCS. Also, Satia M et al 8 reported that, 68% of the patients delivered their previous child by LSCS.…”

“…Delay in approach leads to adverse perinatal outcomes. 4,5 The commonest indications demanding EOH were uterine atony & uterine rupture. However, recently it has been noted that these indications are followed by placenta accrete.…”