Emergency Cesarean Hysterectomy Among Women attending to Obstetric Unit in Al-Thowrah Hospital, Sana,a City, Yemen

Abstract

Background: Peripartum hysterectomy is a major operation and is invariably performed in the presence of life threatening hemorrhage during or immediately after abdominal or vaginal deliveries. Aim: To determine the incidence and indication of cesarean hysterectomy, among women attending to the obstetric unit in Al-Thowrah modern general hospital, Sana, a City, Yemen.  Methods: A total of 60 women cesarean underwent hysterectomy were enrolled in the study. Data were collected from labor registers, theater records, patient cases notes, ward registers and intensive care unit records. Results: During the period of study there were 60 cesarean hysterectomy and 54500 deliveries, representing an incidence rate of 1.1 cases per 1000. Vaginal delivery was the most common mode of delivery (83.3%) followed by a cesarean section (16.7%), and cesarean hysterectomy (0.11%). Most of the women with cesarean hysterectomy were in the age group of 30-39 years (56.7%), 23.3% of women were older than 40 years,  and the least were at age group less than 30 years (20%).  The majority of women were grand multipara (80%) while 16.7% were multipara and only two women (3.3%) were primigravida.  Cesarean hysterectomy was performed in two-thirds of women at the gestational age of 37 weeks or more and in one third at the gestational age of less than 37weeks.  The most common indication for cesarean hysterectomy was rupture uterus (58.3%), massive hemorrhage due to the placenta (15%). Placenta previa, uterine atony, and placenta adherent were indicated in 11.7%, 8.3%, 6.7%, respectively.  There were 53 stillbirths and 7 alive birth. The most common causes of death were placental abruption, ruptured uterus, and prematurity. There was 10 maternal death (16.7%) due to DIC in 6 women as a complication of massive hemorrhage and acute renal failure in 4 patients.  There were 42 maternal complications. These were due to shock (bleeding) in 14, DIC in ten, anemia in eight, acute renal failure in seven, and ureteric ligation in three. Conclusion: The incidence of cesarean hysterectomy was very high, and the most common causes were found to be due to rupture uterus and PPH due to uterine atony and abruption placenta and placenta previa. The maternal mortality rate was found to be very high and the prenatal mortality rate also was very high.