Morbidity And Mortality Following Emergency Obstetric Hysterectomy In Calabar, Nigeria
AbstractObjective: To review the maternal morbidity and mortality following emergency subtotal hysterectomy and total abdominal hysterectomy in the University of Calabar Teaching Hospital (UCTH) the differences in the their outcome and the influence of the cadre of surgeon on the outcome of these procedures.
Design: A ten year retrospective review of cases between 1st January 1990 and 31st December 1999.
Setting: University of Calabar Teaching Hospital, Calabar, Nigeria, a tertiary institution in a developing country.
Patients: Forty – five patients who underwent emergency obstetric hysterectomy
Result: The commonest indications for emergency obstetric hysterectomy were ruptured gravid uterus in 27 (60%). Primary postpartum heamorrhage in 15 (33.3%) of the case and hysterectomy for puerperal sepsis was an indication in 3 (6.7%) of the cases
Complication associated with emergency obstetric hysterectomy were seen in (91. 1%) of the case. These were haemorrrhage 10 (24.4%), wound sepsis 8 (19.5%) septicemia, post operative shock and vesico – vaginal fistula each contributed 3 (7.3%). Others were pelvic abscess in 2 (5.0%), ureteric injury, pulmonary oedema and bed sores contributed (2.4%) each. There were nine maternal deaths giving a case fatality rate (CFT) of 20%. There was no statistical significant difference in the outcome between the two types of hysterectomy. However, when these variables were compared in relation to the cadre of surgeons and the type of hysterectomy, morbidity and mortality were significantly higher amongst the registrars, who however performed better with subtotal hysterectomy than with total abdominal hysterectomy. Suggestions are made on how to reduce the conditions that necessitated these operations and improve the outcome.
KEY WORDS: Morbidity, mortality, Obstetrics hysterectomy
Nigerian Journal of Clinical Practice Vol.6(1) 2003: 52-55