Abstract: Aim & Objectives: The main of the present study to investigate the incidence, risk factors for caesarean hysterectomies and post vaginal emergency hysterectomies.
Methodology: It is prospective study, conducted in the Department of Obstetrics and Gynaecology, S.C.B. Medical College, Cuttack during July 2015 to July 2017.
Results: A total of 55 cases of hysterectomy were operated during this period. Out of all cases, 36 cases (65.5%) of hysterectomy were done following caesarean section and 19 cases (34.5%) following vaginal delivery. The incidence noted was more for cases having delivery by caesarean section. Mean age of the cases was 27.1 years with a standard deviation of 5.2 years. Age ranges was from 19 years to 38 years. But the maximum number of cases were below 30 years of age (80% of cases). Majority of the cases were from rural set up (39 cases, 71%). The rest were from urban set up (29%). Around 40% of the cases (20 cases) of hysterectomy were illiterate, while another 35% (19 cases) just had primary school level of education. It was seen that majority of the cases who underwent hysterectomy were referral cases (46 cases, 83.6%). However, important to note, delayed referral cases were the maximum in this group (35 cases, 63.6% of all cases). Multiparity was seen in most of the cases who underwent hysterectomy (42 cases, 76.4%). One third of all the cases had parity two and was the most common parity presenting for hysterectomy (18 cases, 33%). In the present study, the proportion of cases having hysterectomy was more caesarean section (65%) as compared to cases post vaginal delivery. At least 10% of cases who presented with hysterectomy did not have even a single antenatal check-up during their pregnancy. But most being after three ANCs (mode = 3). Uterine manipulation in the form of previous MTP or Surgery history was found to be present in 23 cases (42%), with previous history of CS being the most common among these, followed by MTP. In the present study, Atonic PPH was the most common indication (58%) for hysterectomy in cases of vaginal delivery followed by scar rupture (32%) while scar rupture and uterine rupture both contributed equally (28% each) for a hysterectomy in cases of caesarean section. It was seen that the mean duration of stay in hospitals in case of caesarean hysterectomies was more as compared to the vaginal hysterectomies and this was found to be statistically significant. It was seen that caesarean hysterectomy was associated with less deaths than expected as compared to vaginal hysterectomy. Intrauterine death was seen in 28 cases (42%), with another 10 cases (15%) born alive but needing NICU admission. There was no complication seen only among 28 cases (43%). Duration of hospital stay, induced labour and history of previous caesarean section were found to have significant association with the type of hysterectomy (p<0.05).
Conclusion: In conclusion, the risk factors associated with emergency peripartum hysterectomy should be identified antenatally and the high risk group of women should be delivered by skilled birth attendants and following protocols of action, measures that can contribute to reduce the high maternal morbidity and mortality associated to EPH. Also, caesarean delivery should be performed only when exclusively necessary, in appropriate clinical settings and by experienced surgeons when such risk factors are identified.
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