Uma Maheswari, - (2010) Emergency Obstetric Hysterectomy: A Retrospective Analytical study over past 10 years. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Obstetrics is a bloody business. Even though the maternal mortality has been reduced dramatically by hospitalization for delivery and the availability of blood for transfusion, death from haemorrhage remains prominent. Obstetrical haemorrhage is most likely to be fatal to mother in circumstances in which blood and blood components are not available immediately. The establishment and maintenance of facilities that allow prompt administration of blood are absolute requirement for acceptable obstetrical care. Hysterectomy was originally employed in Obstetrics a hundred years ago as a surgical attempt to manage life threatening Obstetrical haemorrhage and infection. Now a day it is generally performed as a life saving procedure in cases of rupture uterus, resistant PPH, morbid adhesion of placenta and uterine asepsis. On one hand it is used as a last resort to save a mother’s life. On the other hand a women’s reproductive capability is sacrificed. It is pathetic to perform an emergency hysterectomy on a young primi especially when the baby is dead or moribund. Often it is a difficult decision and requires a good clinical judgement. More often it needs to be carried out when the mother’s condition is too critical to withstand the risks of surgery and anaesthesia. Performing an emergency hysterectomy on a vascular gravid uterus often distorted due to rupture needs expertise. The maternal outcome greatly depends upon the timely decision, the surgical skills and the speed of performing. AIM OF THE STUDY: Hysterectomy performed at or following delivery may be lifesaving if there is severe obstetrical haemorrhage. Emergency Obstetrical Hysterectomy remains an essential weapon in any Obstetrician armoury. Hence it is important to know the general indices, changing trends and indications of this weapon. Hence these are major indications for emergency Obstetric Hysterectomy. In my study it includes Hysterectomy following resistant atonic PPH, ruptured uterus and placenta accrete. It includes Hysterectomy for lower segment bleeding associated with uterine incision, placental implantation or laceration of major uterine vessels also. Hysterectomy following both vaginal delivery and Caesarean section are included. Hysterectomy for large symptomatic myomas, septic abortion, hydatiform mole, carcinoma cervix, Carcinoma endometrium are excluded from my study. Hysterectomy in early pregnancy for non-Obstetrical indications are also excluded. KEEPING THIS IN MIND THAT THE PRESENT STUDY WAS UNDERTAKEN WITH AN AIM TO EVALUATE THE INCIDENCE, MATERNAL PROFILE, INDICATIONS, TYPE, NO OF TRANSFUSIONS, MATERNAL OUTCOME AND HOW THEY ARE BEHAVING OVER PAST 10 YEARS (2000-2009) IN OUR INSTITUTION. Emergency postpartum hysterectomy is associated with significant blood loss, need for transfusion, postoperative complications and longer hospitalization partly because of its indications. MATERIALS AND METHODS: Emergency obstetric hysterectomy encompasses hysterectomies that were performed in the immediate postpartum period both following normal delivery and Caesarian sections. When it follows caesarian section it is called caesarian hysterectomy. If it follows normal delivery means it is post partum hysterectomy. Peripartum hysterectomy includes both. Case sheets of emergency hysterectomy for these major indications [resistant atonic PPH, rupture uterus, adherent placenta] were taken and analysed. It is a retrospective analytical study over past 10 years 2000-2009 in our ISOKGH institution. Forty nine cases were done during 1990-1999. All 49 case records were available for analysis. Each case record is analysed in detail in regard of age, parity, booking status, whether referral or not, indication type of hysterectomy, and post operative complications. Detailed history and examination findings from case sheet noted. Emphasis was given on any obstetric interference /previous surgeries and risk factors. Previous caesarian, CPD, grand multi, malpresentations, Forceps/ Vaccum, Oxytocin/Gel induction, manual removal of placenta, previous MTP, placenta praevia, PIH, diabetes risk factors present in each case noted. Preoperative and post operative haemoglobin values noted. SUMMARY AND CONCLUSION: The Incidence of emergency obstetric hysterectomy in our study was 0.4/1000 live births. Incidence being comparable with changing trends of emergency hysterectomy - (karen M flood 2005), Rotunda hospital Ireland. Incidence emergency hysterectomy is also rising slowly 0.3/1000 in 2000 to 0.7 2009 . Incidence of obstetric hysterectomy following caesarian section being 0.7/1000 live births. Incidence being comparable with ADESIYUM ADIEBI 2008 Nigerian studies. Majority of women 69.4% belonging to the age group 26 to 35 years. Two cases in the age group 20 years and in the age group 48 years. Parity distribution also positively skewed no of cases increases with parity. Analysis of age and parity distribution was also done. Sixty two percent of the cases were unbooked and booked outside. Sixty percent of the cases were referred from outside, previous caesarian being the major risk factor. Atonic PPH being the most common indication for emergency hysterectomy present in 45% of cases. Rupture uterus in 37% Adherent placenta in 16% adherent placenta leads to fundaL rupture in2%.These figures are comparable with studies of George daskalaki et al. 2007, Greece. Rupture uterus cases are on increase from one in 2000 to 4 in 2008 along with rising caesarian delivery rate. In 70% of cases subtotal hysterectomy was done as it has less operating time and less morbidity comparing with total hysterectomy. The need for blood transfusion reduced from 5.3 in 2000 to 2.9 in 2009 due to reduction in operating time and early decision blood is essential and life saving in cases of emergency hysterectomy. There were 4 maternal deaths giving the mortality rate as 8% comparable with Kant Anita (2003) which appears to be the Indian average.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Emergency obstetric hysterectomy ; retrospective analytical study ; over past 10 years. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 12:29 |
| Last Modified: | 09 Dec 2017 13:18 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4103 |
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