Emergency obstetric hysterectomy in the era of rising caesarean sections

ABSTRACT

Objective. Emergency obstetric hysterectomy (EOH) is a life-saving procedure when all other measures fail to control haemorrhage in obstetric emergencies. Our hospital based retrospective study aims to evaluate the incidence, demographic profile, risk factors, clinical indications, and outcomes associated with EOH.

Materials and Methods. A retrospective analysis was conducted encompassing 34 cases of EOH out of 12,782 deliveries within a duration of 4 years and 2 months. Variables examined included maternal demographics, obstetric history, surgical indications, perioperative complications, maternal and foetal outcomes.

Results. The incidence of EOH was 0.26% (1 in 376 deliveries). The median maternal age was 31 years, with multigravida status in 85.3% of cases. A history of caesarean section was documented in 76.5%, and placenta previa in 44.1%. PAS constituted the leading indication (58.8%) for EOH, followed by atonic postpartum haemorrhage (20.6%) and uterine rupture (20.6%). Primary mode of delivery was caesarean section in our cases (82.3%). Postoperative intensive care was required in 88.2% of cases, with major complications comprising anaemia (70.6%) followed by haemorrhagic shock (29.4%). Maternal mortality was observed in 5.8% of cases and foetal mortality predominantly was attributed to prematurity, with neonatal survival in 67.6% cases.

Conclusions. EOH remains indispensable for life-threatening obstetric emergencies. The predominance of PAS underscores the necessity for judicious use of caesarean section. Enhanced antenatal risk stratification and robust tertiary support infrastructure, including rapid-access blood bank and intensive care facilities, will help to optimize maternal and neonatal outcomes