Citation Information :
Ala SH, Husain S, Hussain S. Changing Prevalence of Emergency Obstetric Hysterectomy, Its Indications and Maternal Outcomes Over a 4-year Period at a Tertiary Care Center in Pakistan. J South Asian Feder Obs Gynae 2022; 14 (6):690-693.
Aim: The aim of this study is to assess the prevalence, indications, and maternal outcome of emergency obstetrics hysterectomy and to determine the change in trend in indications of emergency obstetrics hysterectomy in a tertiary care center in Pakistan.
Materials and methods: This retrospective, observational analytical study was conducted in the Department of Obstetrics and Gynecology – Unit-III of Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan from 2016 to 2019. All patients who had undergone emergency obstetrical hysterectomy from January 2016 to December 2019 were enrolled in the study. Data were collected from files and registers. The rate for emergency obstetric hysterectomy (EOH) was calculated. The indications for hysterectomy were also noted. Maternal outcomes including injury to organs, transfusions of blood and its products, intensive care unit (ICU) admissions, and maternal death were secondary outcome measures.
Results: Over a 4-year period between January 2016 to December 2019, 15,040 women were delivered, and out of these, 202 underwent EOH. The prevalence of EOH was 13.42 per 1,000 deliveries. The rate was 0.37% in 2016, 0.58% in 2017, 1.76% in 2018, and 2.48% in 2019. Overall, the most common indication for hysterectomy was morbidly adherent placenta (MAP) 64 (31.7%) followed by postpartum hemorrhage 60 (29.7%). There was a gradual change in indications for EOH; in 2016 only one EOH was due to MAP, whereas in 2019, 34 (33%) EOHs were due to MAP. Out of these 202 women, 29 (14.4%) succumbed to death.
Conclusion: There was a sharp increase in the rate of EOH from 2016 (0.37%) to 2019 (2.48%). Morbidly adherent placenta has become the leading indication for EOH. Policymakers need to take necessary action to reduce the cesarean section rate.
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