Emergency obstetric hysterectomy (EOH) can be a life-saving intervention for cases of severe intra-or postpartum hemorrhage (PPH).
In developed countries, despite advanced modalities such as uterine artery embolization, EOH remains the mainstay of treatment for intractable hemorrhage.
All women requiring EOH for uncontrollable major hemorrhage in the department of Obstetrics and Gynecology UnitII, Civil Hospital, Karachi were included.
Table-I: Demographic characteristics of 32 patients who underwent EOH.
Table-III: Morbidity associated with EOH in 32 patients.
During the two-year study period a total of 7,968 deliveries were performed, of which 32 were EOH yielding a prevalence of 4.01 per 1,000 deliveries.
Atony was also the most common reason for EOH in studies published by Varras and Rabiou et al.9,10 Conversely, morbidly adherent placenta and placenta previa have been found as the primary etiological causes for EOH in several other studies.8,11 One study from a private University Hospital reported that morbidly adherent placenta was the most common cause of EOH.12 The authors concluded that a rising rate of caesarean sections was responsible for the increased incidence of EOH, resulting in adherent placentas.
Morbidly adherent placenta was the second leading cause of obstetric hysterectomy in our patient population, with 9(28%) patients undergoing EOH for this reason.
A multidisciplinary approach including surgeons, anesthetists, interventional radiologists, midwives, nurses and the blood blank services should be involved.14 Despite regular availability of contraceptives and reduced family size world over, there has still been a consistent rise in the rates of caesarean deliveries giving rise to complications like abnormal placentation and uterine rupture, but also the incidence of PPH, giving obstetric hysterectomy more relevance in present day modern obstetric practice.15 Though EOH is often considered a life-saving procedure, it can be associated with a significant post-operative burden.
EOH can be rightly classified as a near miss event.16
Limitations of the Study: As a tertiary hospital based study, rates of EOH were significantly higher than the general population as we receive referrals from neighboring hospitals and cater to nearby rural areas.