Emergency obstetric hysterectomy in a Nigerian teaching hospital: a ten-year review

Abstract

Background: Haemorrhage is a leading cause of maternal mortality worldwide and hysterectomy may become necessary to save life. This procedure is associated with significant morbidity and mortality.

Objective: To determine the, indications, risk factors and the management outcome for the procedure in our unit.

Methods: A retrospective case controlled study of 34 cases of emergency obstetric hysterectomy (EOH) performed at the Lagos University Teaching Hospital over a period of ten years was carried out.

Results: The incidence of EOH was 2.56 per thousand deliveries. Increasing parity, history of previous caesarean section, placenta praevia and current delivery by caesarean section were significant risk factors for the procedure. The indications were ruptured uterus (61.8%), intractable haemorrhage during caesarean section (32.4%), and uterine atony (5.9%). Majority (73.5%) of the patients had subtotal hysterectomy but the outcome indices were similar for the total and subtotal procedures. The case fatality rate was 11.8%. Post-operative complications included anemia (100%), urinary tract infection (UTI) (14.7%) and wound infection (11.7%).

Conclusion: The incidence of EOH in our unit has increased since the last study published in 1983, but the associated mortality has decreased. The indications differed in proportion from those in developed countries although the risk factors were similar. The outcome indices were similar for the total and the subtotal procedures. EOH is still associated with considerable maternal morbidity and mortality which can be reduced by provision of better obstetric care for the population.

Keywords: Haemorrhage, Obstetric hysterectomy, caesarean section, placental praevia, maternal mortality