Emergency Obstetric Hysterectomy in Abba, Saudi Arabia: A 15-Year Review of 72 Cases

Objectives: To determine the incidence of, indications,associated risk factors, maternal and fetal morbidities andmortalities resulting from emergency obstetrics hysterectomy.Materials and Methods: This was a retrospective studyof 72 patients who had emergency hysterectomy performedat Abha General Hospital, Abba, Saudi Arabia over a 15-yearperiod. According to parity, they were divided into 3 groups,as follows; group I (para 0, n=2), group 2 (para 1-4, n=26)and group 3 (para 5 or more, n=44). A comparison was alsomade according to the type of hysterectomy and history ofprevious Caesarean section.Results: The incidence of emergency obstetric hysterectomywas 1.2 per thousand deliveries; 6 (8.3%) followedvaginal deliveries and 66 (91.7%) after Caesarean section(CS). Major indications were abnormal placentation 40(55.5%), uterine atony, 14 (19.4% ), others (rupture of uterus,DIC, profuse uncontrollable bleeding) were 18 (25%). Identifiablerisk factors included previous Caesarean, 55 (76.4%),maternal age between 30-39 years, 51 cases (70.8% ), andgrand multiparity, 44 (61.1 %). Histopathologically-provenplacenta accreta was found in 8 (30.7%) and 13 (31.8%) ingroups 2 and 3, respectively. There were three maternal deathsin the study and overall perinatal mortality was 8.5%.Conclusion: The incidence of obstetric emergency hysterectomyin this study is 0.12% with an associated maternalmortality of 3 (4.1% ), one of which was attributable to placentaaccreta. Although the major indication was placenta accretain 40 (55.5%) of the cases, this was proven histologically in21 cases (42.5%). The identifiable risk factors are grandmultiparity, maternal age range of 30-39 years and a previousCaesarean section. Proper counseling in these high risk patientsshould be mandatory, efforts should be made to reduce theincidence primary CS, therefore CS hysterectomy by involvingexperienced obstetricians in decision making regarding thecs.