Indications and outcomes of emergency obstetric hysterectomy
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Emergency Obstetric Hysterectomy (EOH) is the removal of the uterus due to life-threatening conditions within the puerperium. This life-saving intervention is associated with life-threatening complications.

This study by BMC Pregnancy and Childbirth was aimed to determine the prevalence, indications, and outcomes of emergency obstetric hysterectomy while comparing both postpartum hysterectomy and cesarean hysterectomy.

A 5-year hospital-based retrospective cohort study involving medical records of patients who underwent emergency obstetric hysterectomies between 1st January 2015 and 31st December 2019, was carried out. Cases were classified as cesarean hysterectomy (CH) or postpartum hysterectomy (PH).

--There were 30 cases of emergency obstetric hysterectomy (24 cesarean hysterectomies and 6 postpartum hysterectomies), giving a prevalence rate of 3.75 per 1000 deliveries.

--The most common indication for CH, was intractable postpartum hemorrhage and uterine rupture, while abnormal placentation was commonly indicated for PH.

--Anemia (both groups) and sepsis (PH group only, 33.33%) were the most statistically significant complications of EOH respectively.

--The absence of blood transfusion prior to surgery and prolonged surgery lasting 2 or more hours, were significantly associated with a negative clinical outcome.

The prevalence of EOH is high. There were no differences in the sociodemographic profile, risk factors, and indications of both groups. PH group was more likely to develop sepsis as a complication. Lack of blood transfusion prior to surgery and prolonged surgeries were significantly associated with complications. Meticulous care and timely recognition of negative prognostic factors of delivery as well as those of EOH will help improve maternal outcomes of pregnancy.

Source: https://doi.org/10.1186/s12884-021-03797-3
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