Indications and Complications of Obstetric Hysterectomy in a Tertiary Care Hospital of Lahore

Objectives: To find out the frequency of obstetric hysterectomy, its indications and associated maternal complications in a tertiary care hospital of Lahore, Pakistan. Methods: This is a retrospective observational descriptive study. It was done in Department of Obstetrics and Gynaecology of a Tertiary Care Hospital, Lahore from Feb 2015 to Jan 2016. All the records of patients, who had undergone hysterectomy, within 24 hours of normal delivery or cesarean section, were reviewed. The details of age, parity, booking status, indication and complications of operation were recorded on a predesigned proforma. Results: The total deliveries during the period were 5, 754. Obstetric hysterectomy was performed in 26 patients. This gives frequency of the emergency obstetric hysterectomy in our unit to be 4.5/1000 births. The major indication was previous cesarean sections with placenta previa and/or accreta in 17 cases (65.38%), followed by massive postpartum haemorrhage due to uterineatony in 4 cases (15.38%), uterine rupture in 3(11.5%)and abruptio placenta in 2 (7.6%). Most common complication was haemorrhagic shock seen in 14 patients. There were 5 cases of bladder injury, 2 Ureteric injury and 2 vault hematomas. Maternal deaths occurred in 3 cases. Conclusion: Emergency obstetric hysterectomy is increasing with increased frequency of cesarean sections and placenta previa and accreta. Antenatal booking of high risk patients, timely referral to tertiary care hospital with good surgical expertise and ICU care can reduce morbidity and mortality in such cases.