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Obstetric hysterectomy: Ramathibodi's experience 1969-1987
C Suchartwatnachai1, V Linasmita, K Chaturachinda
1Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
Summary
Emergency obstetric hysterectomy is often necessary due to uterine atony or placenta accreta. This procedure, while life-saving, carries significant intraoperative and postoperative risks for maternal health.
Area of Science:
- Obstetrics and Gynecology
- Surgical Procedures
- Maternal Health
Background:
- Obstetric hysterectomy is a critical intervention for managing severe obstetric emergencies.
- The procedure's incidence and indications vary geographically and over time.
Purpose of the Study:
- To analyze the incidence, indications, and complications of obstetric hysterectomy.
- To provide insights into the management of severe postpartum hemorrhage and uterine rupture.
Main Methods:
- Retrospective review of 121 obstetric hysterectomies performed between 1969 and 1987.
- Analysis of available records for 88 patients to determine indications and outcomes.
Main Results:
- Incidence of obstetric hysterectomy was 1:875 deliveries.
- Most common indications were uterine atony (32.5%) and placenta accreta (26.2%).
- High rates of febrile morbidity (52%) and intraoperative hypotension (41%) were observed.
Conclusions:
- Obstetric hysterectomy is frequently an emergency procedure driven by atony and accreta.
- Significant maternal morbidity is associated with this surgery, necessitating careful management.
- Long-term complications like Sheehan's syndrome require ongoing monitoring.