A 11-year review of emergency obstetric hysterectomy (eoh) in Hospital Universiti Sains Malaysia Kubang Kerian, Kelantan January 2007 – December 2017
Introduction: Emergency obstetric hysterectomy (EOH) is one of the life saving procedure performed in cases of intractable hemorrhage due to uterine atony, rupture uterus and placental disorders and it is usually reserved for the situations where conservative measures fail to control the hemorrha...
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| Format: | Thesis |
| Language: | English |
| Published: |
2020
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| Online Access: | http://eprints.usm.my/60429/1/DR%20NOOR%20ADIBAH%20HANUM%20BINTI%20CHE%20HASHIM-E.pdf |
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| Summary: | Introduction: Emergency obstetric hysterectomy (EOH) is one of the life saving
procedure performed in cases of intractable hemorrhage due to uterine atony, rupture
uterus and placental disorders and it is usually reserved for the situations where
conservative measures fail to control the hemorrhage. It is sometimes associated with
both maternal and perinatal morbidity and mortality.
Objective: To evaluate the prevalence, indications, maternal and perinatal outcome
associated with emergency obstetric hysterectomy in a tertiary care hospital.
Methodology: A retrospective study conducted in the Department of Obstetric &
Gynaecology in Hospital Universiti Sains Malaysia (HUSM) for 11 years from January
2007 until December 2017 involving a total of 43 women who underwent emergency
obstetric hysterectomy. The records of all cases of emergency obstetric hysterectomy
were analyzed included patient profile, obstetric history, details of present labour, indications for obstetric hysterectomy and the fetomaternal morbidity and mortality
associated with emergency obstetric hysterectomy.
Results: Among 79,777 deliveries, there were 43 cases of emergency obstetric
hysterectomy, giving the prevalence of emergency obstetric hysterectomy was 0.29 per
1000 deliveries. Maternal demographic characteristics showed that mean age was 36
years old in caesarean hysterectomy group while mean age for postpartum hysterectomy
group was 33 years old. The most common parity group encountered in emergency
obstetric hysterectomy was para two to para five. Whether or not women underwent
prior uterine surgery was investigated and 30 women (69.77%) had history of previous
caesarean section. Of the 30 women with an obstetric history of caesarean delivery, 15
(50%) had more than two caesarean deliveries. Placenta accreta was the most common
indication for emergency obstetric hysterectomy (30 women, 69.8%) followed by
uterine atony (10 women, 23.3%), uterine rupture (2 women, 4.7%) and extended tear
(1 woman, 2.3%). Futhermore, about 93.33% (28 out of 30 patients) with adherent
placenta had history of caesarean section prior. No maternal mortality reported in this
study. The most significant maternal complications postoperatively include
coagulopathy (12 out of 43 women), where 27.91% required massive transfusion
protocol, followed with re-laparotomy (4 women, 9.3%), and febrile illness (3 women,
6.98%). Most of the babies were born with good Apgar score. The perinatal
complication include perinatal death, 2 out of 43 babies, 4.65% were fresh stillbirth
were both cases were referred to our center for abruptio placenta.
Conclusions: Caesarean section, especially repeat caesarean sections in women with
placenta previa and uterine atony, significantly increased the risks of emergency obstetric hysterectomy. Emergency obstetric hysterectomy is safe with reduce
complications compared to before with advancement of obstetric care and good clinical
practice. Early decision to perform emergency obstetric hysterectomy is essential before
the patient’s condition deteriorates |
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