Indication of Emergency Hysterectomy in Pakistani Patients
Objective: To determine the frequency of indications and factors leading to emergency peripartum hysterectomy. Methodology: This descriptive cross-sectional study was conducted at the department of obstetrics and gynecology in Jinnah Postgraduate Medical Centre. 104 patients who presented in gestational age 34-40 weeks assessed by last menstrual period and having indication of emergency peripartum hysterectomy. Women of age 20 to 40 years, having at least 1 child were selected. Results: Mean age was 31.94±6.38 (22-40 years). Mean gestational age was 37.44 ± 1.68 (34-40 weeks). Atonic uterus was present in 28.8%, placenta praevia in 11.5%, morbidly adherent placenta in 11.5%, and endometritis was present in 10.6%. Uterine rupture was present in 45.2%, multiple gestations were diagnosed in 23.1% patients, 32.7% patients had gestational diabetes, 30.8% had preeclampsia while the history of the previous caesarean section was present in 35.6%. The frequency of uterine rupture decreased with increasing patient age, increasing gestational age and also with increasing parity. Placenta praevia increased with an increasing maternal age but it decreased with increasing gestational age. The frequency of preeclampsia as a risk factor for emergency peripartum hysterectomy was also affected and it with advanced gestational age. Gestational diabetes as risk factor increased with increasing the age of the patient, increasing gestational age and also the increasing parity (pvalue<0.001). Conclusion: Rupture of uterus, uterine atony, placenta praevia and abnormally positioned placenta are common indications for emergency peripartum hysterectomy. Risk factors are gestational diabetes, preeclampsia, endometritis, multiple gestations and history of previous caesarean sections.