Frequency, Indications and Complications of Obstetrical Hysterectomy

Abstract

Background: Obstetrical hysterectomy is a lifesaving procedure but increasing incidence in both developed and underdeveloped countries is alarming. Objective: To determine the frequency of obstetrical hysterectomy among all deliveries after 24 weeks of gestation and evaluation of indications and complications. Study Design: Cross sectional retrospective study. Settings: Department of Gynecology & Obstetrics, DHQ Hospital, Faisalabad Pakistan. Duration: One year from December 2018 to November 2019. Methods: All the patients who had obstetrical hysterectomies done after 24 weeks gestation till 42 days after delivery were included in study. Frequency was calculated out of total deliveries after 24 weeks of gestation. Data regarding indications and complications like bladder repair, dialysis, ICU admission, and maternal death was collected on a pre-designed proforma from hospital record and was analyzed. Results: Total deliveries were 7879. Frequency of obstetrical hysterectomy was 4.6/1000 deliveries. Out of these 67.5% patients had previous cesarean section. The most common indication was morbidly adherent placenta 22(59.4%) followed by ruptured uterus 9(24.3%) and uterine atony 6(16.2%). Whereas regarding complications 6(16.2%) patients were shifted to ICU, bladder injury occurred in5 (13%), 2 patients needed dialysis and maternal mortality was 5(13%). Conclusion: Morbidly adherent placenta was the most common cause of obstetrical hysterectomy followed by unrepairable ruptured uterus and uterine atony. The complications in the descending order were ICU admission, bladder damage, maternal death and dialysis.