MORBIDITY AND MORTALITY ASSOCIATED WITH OBSTETRIC HYSTERECTOMY
AbstractBackground: Obstetric hysterectomy still complicates a substantial number of pregnancies inthird world countries and is a significant cause of obstetric morbidity and mortality. This studywas carried out to evaluate in our setup the frequency of obstetric hysterectomy, its indication, riskfactors, complication, morbidity, mortality and avoidable factors. Methods: A descriptive study ofall patients who under went obstetric hysterectomy was conducted from 1st May, 2004 to 31stOctober, 2005 at Gynaecology and Obstetric Unit-II, III of Liaquat University of Medical andHealth Science Hospital, Hyderabad. After collecting the data on pre-designed proforma the datawas fed to SPSS in the form of frequency distribution tables and percentages were calculated.Statistical analysis of data was performed by using Chi-square test. The level of significance wastaken as p<0.05. Results: During the study time period there were total 6495 deliveries and 41cases of obstetric hysterectomy were identified, giving a frequency of 0.63% or 1 in 158deliveries. Most of patients were from rural areas (82.92%), un-booked 73.17%), uneducated(95%), lower socioeconomical class (92.69%), 25–29 years age (48.78%) multiparae (56.10%),have to travel a distance of <100 km to reach hospital and referred late (51%) by healthcareproviders (doctors). Majority of hysterectomies were performed due to ruptured uteri (51.21%).There were 5 maternal and 26 perinatal deaths; all were due to severity of conditions necessitatinghysterectomy. Conclusion: Incidence of obstetric hysterectomy in our woman is very high. Thereason being many avoidable factors such as high parity, inadequate maternity and familyplanning services, lack of proper referral system, un-booked status, mismanaged labour, illiteracyon the part of woman herself, family and health care providers are not taken care of duringpregnancy, labour and puerperium.Keywords: Obstetric hysterectomy, multiparity, Injudicious use of oxytocics, uterine rupture,maternal morbidity and mortality
Najmi RS. Caesarean and postpartum hysterectomy - a study
from lahore. J Coll Physicians Surg Pak 1994;4:120–5.
Gupta S, Hooker J, Beynon JL, Gibson JRM Obstetric
Hysterectomy. J Obstet Gyneacol 1994;14:159–61.
Korejo R, Jafarey SN. Obstetric Hysterectomy: five years
experience at Jinnah Postgraduate Medical Centre, Karachi. J
Pak Med Assoc 1995;45:86–8.
Onwudiegwu U, Okonofua FE. Emergency obstetric
hysterectomy in a Nigerian hospital. J Obstet Gynecol
Baskett TF. Emergency obstetric hysterectomy. J Obstet
Stanco LM, Schrimmer DB, Paul RH, Mishell DR. Emergency
Peripartum hysterectomy and associated risk factors. Am J
Obstet Gynecol 1993;168:879–83.
Qureshi RN. Emergency obstetrical care. In: Farooque MS,
Samad S, eds. A manual for Physicians, Reproductive Health.
Karachi: College of Physicians and Surgeons Pakistan; 2002.p.
Begum I, Khan A, Khan S, Begum S. Caesarean and
Postpartum hysterectomy. Pak J Med Res 2004;43:134–7.
Ehsan N, Mehmood A. Emergency peripartum hysterectomy: a
J Ayub Med Coll Abbottabad 2010;22(2)
study of 96 cases. Pak J Surg 1998;14:45–9.
Gould DA, Butler-Manuel SA, Turner MJ, Carter PG.
Emergency obstetric hysterectomy an increasing incidence. J
Obstet Gynaecol 1999;19:580–3.
Zorlu CG, Turan C, Isik AZ, Danisman N, Mungan T, Gokmen
O. Emergenc hysterectomy in modern obstetric practice
changing clinical perspective in time. Acta Obstet Gynaecol
Shoaib F. Emergency Obstetric hysterectomy. J Coll Physicians
Surg Pak 1996;6:319–22.
Sachdev PS, Munir A. Obstetric Hysterectomy. Pak J Obstet
Roopnarineshing R, Fayl, Mckenna P. A 27 year review of
Obstetric hysterectomy. J Obstet Gynaecol 2003;23:252–4.
Rana T. Emergency obstetric hysterectomies indications and
complications Pak J Obstet Gynaecol 1998;11:90–2.
Parveen S. Emergency Caesarean hysterectomy. J Surg Pak
Noor S, Majid S, Ruby N. An audit of Obstetric hysterectomy.
J Coll Physicians Surg Pak 2001;11:642–5.
Abbasi RM, Mumtaz F, Mughal R. An audit of indications and
complications of Obstetric hysterectomy at a tertiary care
hospital of Hyderabad. J Liquat Uni Med Helth Sci
Tahir S, Aleem M, Akram S. Indication and maternal outcome
of emergenc peripartum hysterectomy. Pak J Med Science
Zelop CM, Harlow BL, Frigoletto FD, Safon LE, Saltzman DH.
Emergency peripartum hysterectomy. Am J Obstet Gynecol
Tallab F, Helewa M. Peripartum hysterectomy: 10 year
experience in two Manitoba tertiary centers. Annals Saudi Med
Daskalakis G, Anastasakis E, Papantoniou N, Mesogitis S,
Theodora M, Antsaklis A. Emergency obstetric hysterectomy.
Acta Obstet Gynecol Scand 2007;86:223–7.