Emergency Obstetric Hysterectomy: A life saving procedure

Abstract

Objective: To determine the incidence, indications, associated factors and complications of obstetric hysterectomy in study patients. Design: Retrospective, observational study. Place & Duration of Study: Gynae unit III, Lady Willingdon Hospital Lahore, affiliated with King Edward Medical College Lahore. Study Period: January 2002 to December 2003. Materials & Methods: During the mentioned period patients admitted in labor room and had obstetric hysterectomy were included in the study. The data reviewed included patient profile, socioeconomic status, obstetric history, antenatal booking, details of present labor, indications for obstetric hysterectomy and the fetomaternal morbidity & mortality associated with the obstetric hysterectomy. Results: The study shows the relative risk of obstetric hysterectomy among unbooked versus booked patient was 2. Most of the patients were unbooked and had prolonged trial of labor out side the hospital. A trend between the advancing age and the incidence was found. In the study 16/28 (i.e., 57%) patients belonged to age group between 30-35 years. Increasing parity had relation with the increasing incidence of obstetric hysterectomy, 18/28 (64.5%) were Para 4 or more. The most common indication of obstetric hysterectomy was ruptured uterus in 11 / 28 (i.e. 30%) patients. Out of 28 patients who had obstetric hysterectomy, 2 patients died. The other complications were febrile morbidity in 57%, UTI in 50%, wound infection in 21%, urinary bladder injury in 7% and DVT in 3.5%. Conclusion: Regular antenatal care, supervised deliveries, early referral of indicated cases to the hospital and limiting family size can reduce the maternal morbidity & mortality.