Obstetric Hysterectomy in the Current Scenario: A Prospective Study on Incidence, Indications, and Maternal Complications in a Tertiary Care Hospital of Eastern India

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Aim and background: Obstetric hysterectomy (OH) is a major lifesaving surgery done during delivery (vaginal/cesarean), any time within 42 days after birth or following abortion.Even after advances in medical management, the rate of OH is increasing worldwide.The aim of this study was to identify the risk factors for the rising incidence and to estimate the current incidence and indications of OH. Materials and methods: This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, R.G. Kar Medical College and Hospital, Kolkata, for a period of 1 year, where all the pregnant women undergoing OH during or within 42 days of delivery (cesarean/vaginal) and following early pregnancy events were included. Result and analysis:The incidence of OH was found to be 1.8 per 1,000 deliveries, with an average age of 30 years.Most of the patients were economically poor, referred from the periphery, and had a history of poor or no antenatal care.A total of 71.42% of patients had had one or more previous cesarean sections (CSs).Previous abortion, short interpregnancy interval, and multigravida were other risk factors.Postpartum hemorrhage (PPH) was the commonest indication (59.09%), followed by adherent placenta and ruptured uterus.Peroperative complications were low; one patient experienced bladder injury, and maternal mortality was 4.5% [one mother died following acute renal failure (ARF)].Conclusion: In this study, we tried to estimate the current incidence and indications of OH and also to find out the risk factors leading to an increase in the incidence of OH.Clinical significance: Community education regarding birth spacing, adoption of family planning measures, adequate antenatal care, comprehensive abortion care, and institutional delivery are all important tools for primary prevention.Reducing the number of primary CSs will play a major role to reduce such procedures.Careful labor monitoring, active management of the third stage, prompt decision, timely referral, and intervention are the important measures for secondary prevention.

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