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An audit of indications and complications of Obstetrical Hysterectomy at a tertiary care hospital of Hyderabad

Razia Mustafa Abbasi, Firdous Mumtaz, Razia Mughal..

OBJECTIVE: To study the indications and complications of emergency obstetrical hysterectomy in our set up. SETTING: This study was conducted at Gynae Unit III of Liaquat University Hospital Jamshoro, Pakistan, for the period of 1st April 2001 to 31st March 2002. METHODS: This prospective study was conducted on 20 patients, in whom emergency obstetrical hysterectomy was performed. All the clinical details, operative findings, indications for hysterectomy and post-operative complications were analysed. All the patients received liberal blood transfusion, pre and post operatively broad spectrum antibiotics. Most of the cases were performed by duty resident medial officer but every surgical intervention was carried out under the supervision of senior consultant. RESULTS: Out of total 2305 obstetric admissions, 1550 patients delivered normally. This included 400 (17.35%) cesarean sections and 20 (1.25%) patients had obstetrical hysterectomy, thus, the incidence of obstetric hysterectomy was found 0.1% deliveries. Obstetrical hysterectomy was performed mainly because of ruptured uterus. Other indications included septic uterus. Uterine atony and morbid adherence of placenta. Nearly all patients had total abdominal hysterectomy. Despite all emergency measures 4 (20%) maternal deaths occurred, while 16 (80%) patients survived. Post operative morbidity occurred in 60% case and 20% had no complication. CONCLUSION: Obstetrical emergency hysterectomy remains a necessary procedure for life saving during abdominal and vaginal deliveries. It can be avoided by Good antenatal care, early diagnosis of placental abnormalities, thickness of scar by ultrasound and by better monitoring facilities during labour.

Key words: Hysterectomy. Hospitals, University. Cesarean Section. Hysterectomy, Vaginal. Uterine Inertia. Postpartum Hemorrhage. Uterine Diseases. Placenta Accreta. Hospitals, Teaching.

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