Emergency Obstetric Hysterectomy:  A Three - Year Retrospective Study in Ajmer

Swati .; Deepali  Jain; Manoj  Kumar; Neelam  Saini

Swati . Senior Resident, Department of Obstetrics & Gynecology, J L N Medical College, Ajmer
Deepali Jain Post-graduate student, Department of Obstetrics & Gynecology, J L N Medical College, Ajmer, India.
Manoj Kumar Assistant Professor, , Department of Paediatrics, J L N Medical College, Ajmer, India
Neelam Saini Post-graduate student, Department of Obstetrics & Gynecology, J L N Medical College, Ajmer, India.

Keywords: Emergency obstetric hysterectomy, indications, mortality, morbidity.

Abstract

Background: Emergency obstetric hysterectomy continues to remain an important life-saving procedure in the era of modern obstetrics.
Objective:To determine the prevalance, related factors, and outcomes of obstetric hysterectomies. Study Design: Setting: Tertiary hospital of the Rajkiya Mahila Chikitsalaya and JLN Medical College in Ajmer, India. Method: Retrospective, cross-sectional study, of 52 obstetrical hysterectomies performed between January 2014 and December 2016 in 41,470 deliveries.
Results: Frequency was 0.125% or 1 every 797.5 deliveries. Maternal age was predominantly between 26 to 30 years (46.15%). Patients mainly had two ante-natal visits at the Anganwadi and/or sub-center level (76%). The majority of patients were para 3 (40.38%), and 73.07% patients (38) were referred from rural areas. The average distance of rural areas from where these referred cases were received was 63 kilometers. The indications were severe atonic postpartum hemorrhage (34.62%), uterine rupture (30.76%), placental causes (26.92%), abortion-related complications (5.77%) and one case of uterine perforation (with fecal peritonitis) following postpartum intrauterine contraceptive device removal (1.92%). While the mortality rate was 28.85% among these hysterectomy patients, the major morbidities after obstetric hysterectomy were severe anemia requiring blood transfusions (30.77%), pyrexia (15.38%), bladder/renal complications (13.46%), paralytic ileus (11.54%), disseminated intravascular coagulation (9.62%) and wound sepsis (7.69%). Peri-natal mortality was 44.22%, average hospital stay was 13
days, and 15.38% of uterine specimens showed adenomyosis on histo-pathology.
Conclusion: Obstetric hysterectomy reflects a public health problem in our region therefore, better obstetrical care and greater emphasis on public health is required to decrease maternal mortality and morbidity.