Saima Javaid, Tahira Yasmeen, Salma Rafique, Salim Malik.
Postpartum and emergency caesarean hysterectomy.
Pak J Med Health Sci Jan ;5(2):239-42.

Objective: To study the frequency, indication, maternal and fetal outcome of emergency caesarean hysterectomy and discuss new trends of management of postpartum hysterectomy. Background: Caesarean hysterectomy is a surgical procedure and is an obstetrical emergency. It is performed for indications like postpartum haemorrhage, uterine rupture, placenta praevia and abruptio placentae. It can be performed after normal delivery, caesarean sections and after instrumental vaginal deliveries. Study design: It is a retrospective study. Setting and duration: Nawaz Sharif Social Security hospital, Lahore, Gynaecology department from January, 2009 to December, 2010. Methodology: Parameter analyzed were frequency, indication, maternal characteristics, maternal and perinatal morbidity and mortality. Results: The frequency of emergency caesarean hysterectomy over a study period was 0.309%. Most common indication for operation was caesarean section for placenta praevia 38.4%, followed by uterine atony 23.07% and broad ligament haematoma leading to intractable haemorrhage in 15.38%. Out of 13 patients 12 had total abdominal hysterectomy and one subtotal hysterectomy. Most common maternal complication was anaemia 92.30% followed by fever and wound infection. There was no maternal death but four perinatal deaths because of prematurity. Conclusion: Frequency of emergency caesarean hysterectomy is high in our setup. High parity increase number of caesarean section and abnormal placentation were identified as risk factors for emergency caesarean hysterectomy. Postpartum hysterectomy is a life saving procedure. The maternal outcome greatly depends on timely decision and good clinical judgement because unnecessary delay can cost life and undue haste can cause morbidity.

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