MORBIDITY AND MORTALITY ASSOCIATED WITH OBSTETRIC HYSTERECTOMY

Authors

  • Najma Bano Shaikh
  • Shabnam Shaikh
  • Jan Muhammad Shaikh

Abstract

Background: 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

References

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

;15:24–6.

Baskett TF. Emergency obstetric hysterectomy. J Obstet

Gynecol 2003;23:353–5.

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.

–9.

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)

http://www.ayubmed.edu.pk/JAMC/PAST/22-2/Najma.pdf

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

Scand 1998;77:186–90.

Shoaib F. Emergency Obstetric hysterectomy. J Coll Physicians

Surg Pak 1996;6:319–22.

Sachdev PS, Munir A. Obstetric Hysterectomy. Pak J Obstet

Gynaecol 1996;9:31–4.

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

;10(3):27–30.

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

;1(1):17.

Tahir S, Aleem M, Akram S. Indication and maternal outcome

of emergenc peripartum hysterectomy. Pak J Med Science

;19:182–6.

Zelop CM, Harlow BL, Frigoletto FD, Safon LE, Saltzman DH.

Emergency peripartum hysterectomy. Am J Obstet Gynecol

;168:1443–8.

Tallab F, Helewa M. Peripartum hysterectomy: 10 year

experience in two Manitoba tertiary centers. Annals Saudi Med

;18:398–400.

Daskalakis G, Anastasakis E, Papantoniou N, Mesogitis S,

Theodora M, Antsaklis A. Emergency obstetric hysterectomy.

Acta Obstet Gynecol Scand 2007;86:223–7.

Published

2010-06-01