Assesement of prevalence, outcomes and associated risk factors of obstetric hysterectomy: at tarcha general hospital, tarcha, southern, Ethiopia.

Abstract

INTRODUCTION: Obstetric hysterectomy is indicated when patient's life is at risk, related to significant maternal mortality and morbidity and it is also a potentially lifesaving procedure. In developed countries, the reported incidence of emergency hysterectomy is below 0.1% of the total normal deliveries performed, while in developing countries, the incidence rates are as high as 1-5/ 1000 of all the deliveries performed. OBJECTIVES: the aim of the study was to assess prevalence, outcome and associated risk factors of obstetric hysterectomy at Tarcha General Hospital: from April 2000 to April 2006 EC. METHDS AND MATERIALS: A facility based retrospective cross sectional review of obstetric records was reviewed over a period of seven years (April 2000 to April 2006 EC). Study was conducted from March2006 to Jun 2006 EC. All women treated at Tarcha General Hospital for the indication of obstetrics hysterectomy were included in the study. Data was collected with structured format by five trained data collectors. Results were analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0. For all statistical significance tests the cutoff value set is P<0.05 and binary logistic regressions were used to estimate the crude odds ratios of maternal outcome. RESULTS- The mean (±SD) age of the patients was 30.09± (0.61) years; a total of 9875 confinements and 65cases of OH was undertaken during the study period to give an incidence of 6.6/1000 deliveries with a maximum numbers of patients (n=20, 27.4 %) in the age group of >35yrs and mean age and parity of 3-4 (46.5%). Ruptured uterus (n=53, 81.5%), morbid adherent placenta (n=4, 6.2%).), uterine atony 3(4.6%) sepsis and perforated uterus secondary to destructive delivery (n=5, 7.7%) were the commonest causes for this life saving surgery. Out of the 65 hysterectomies performed, 48 (73.8%) were total hysterectomy and 17(26.2%) were subtotal hysterectomy. There were six maternal deaths (9.2%). Patients who had no ANC follow up visits (OR=7.5, CI=2.64-21.28) were statistically associated with unfavorable maternal out come. CONCLUSION AND RECOMMENDATION: The incidence of OH and maternal death in Tarcha General Hospital was high. Good maternal care, ANC follow up, active management of labor, early recognition of complications and timely referral will go a long way in ensuring for a better outcome.