Emergency Obstetric Hysterectomy in Abha, Saudi Arabia: A 15-Year Review of 72 Cases
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- Category: Vol. 77, June 2009
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Emergency Obstetric Hysterectomy in Abha, Saudi Arabia: A 15-Year Review of 72 Cases, ADEKUNLE A. SOBANDE and MONA A. ALMUSHAIT
Abstract
Objectives: To determine the incidence of, indications, associated risk factors, maternal and fetal morbidities and mortalities resulting from emergency obstetrics hysterectomy.
Materials and Methods: This was a retrospective study of 72 patients who had emergency hysterectomy performed at Abha General Hospital, Abha, Saudi Arabia over a 15-year period. According to parity, they were divided into 3 groups, as follows; group 1 (para 0, n=2), group 2 (para 1-4, n=26) and group 3 (para 5 or more, n=44). A comparison was also made according to the type of hysterectomy and history of previous Caesarean section.
Results: The incidence of emergency obstetric hysterec-tomy was 1.2 per thousand deliveries; 6 (8.3%) followed vaginal deliveries and 66 (91.7%) after Caesarean section (CS). Major indications were abnormal placentation 40 (55.5%), uterine atony, 14 (19.4%), others (rupture of uterus, DIC, profuse uncontrollable bleeding) were 18 (25%). Iden-tifiable risk factors included previous Caesarean, 55 (76.4%), maternal age between 30-39 years, 51 cases (70.8%), and grand multiparity, 44 (61.1%). Histopathologically-proven placenta accreta was found in 8 (30.7%) and 13 (31.8%) in groups 2 and 3, respectively. There were three maternal deaths in the study and overall perinatal mortality was 8.5%.
Conclusion: The incidence of obstetric emergency hys-terectomy in this study is 0.12% with an associated maternal mortality of 3 (4.1%), one of which was attributable to placenta accreta. Although the major indication was placenta accreta in 40 (55.5%) of the cases, this was proven histologically in 21 cases (42.5%). The identifiable risk factors are grand multiparity, maternal age range of 30-39 years and a previous Caesarean section. Proper counseling in these high risk patients should be mandatory, efforts should be made to reduce the incidence primary CS, therefore CS hysterectomy by involving experienced obstetricians in decision making regarding the CS.