Ten years experience of caesarean and postpartum hysterectomy in a teaching hospital in Hong Kong.

OBJECTIVE

To review 10 years' experience of obstetric hysterectomy in a university teaching hospital.

STUDY

DESIGN

A retrospective study of all cases of caesarean or postpartum hysterectomy between 1984-1994. Demographic data and clinical details including indications for operation, nature of surgical management and complications were analysed.

RESULTS

The incidence of obstetric hysterectomy was 1 in 1420 deliveries. Overall, 0.32% of caesarean sections and 0.02% of vaginal deliveries were complicated by emergency obstetric hysterectomy. Morbidly adherent placenta (32.7%) was the most common cause of uncontrollable haemorrhage. Prior caesarean delivery and placenta praevia were the main risk factors for its development. Operative complications included intra-operative hypotension (33.3%), urinary tract injury (22.2%) and re-exploration for persistent haemorrhage (12.5%). There was one maternal death due to suspected air embolism.

CONCLUSIONS

Emergency obstetric hysterectomy, though uncommon, remains a potentially life-saving procedure which every obstetrician must be familiar with. It is extremely important to have early surgical intervention, prompt resuscitation and management by experienced medical staff to minimise morbidity and mortality.