TITLE:
Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis
AUTHORS:
Baguilane Douaguibe, Dédé Régina Ajavon, Komi Migbenya, Pakienyedou Tongou, Francis Bararmna-Bagou, Romario Mawougbe, Samadou Aboubakari
KEYWORDS:
Obstetric Hysterectomy, Indications, Maternal Prognosis, CHU-SO
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.10,
October
24,
2023
ABSTRACT: Obstetric hysterectomy is a surgical procedure most often performed in a
context of extreme emergency in an obstetric environment. The incidence of
obstetric hysterectomy is differently expressed around the world. In the CHU-SO
maternity ward, hemorrhagic obstetric emergencies are common. The extreme
urgency in which patients are admitted, the insufficiency of the technical
platform, associated with the challenge of the availability of blood products,
often leads to performing an obstetric hysterectomy for hemostasis. It is
responsible for high maternal morbidity and mortality. Since 2000 no study has
been carried out on this practice in the service. Objective was to
describe the practice of obstetric hysterectomy at the CHU-SO and
specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method:
A descriptive, cross-sectional, and analytical study was carried out at
the Gynecology-Obstetrics clinic of the CHU-SO; from January 1, 2021, to June
30, 2022. All hysterectomies performed in an obstetric emergency context
(during pregnancy, perpartum or postpartum) in the department were included in our study. We
did not include cases of obstetric hysterectomies outside the SO hospital or
planned non-obstetric hysterectomies. Results: We recorded 75 cases of
obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89
± 5.93. The age group between 30 and 35 years old was the most affected with a
rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for
admission, patients were referred in 80% of cases. The average parity was 3.25
± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%)
were the most affected. The indications frequently found were uterine atony
(44%); uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was
performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses.
Three poor prognostic factors were observed during our study, namely: uterine
atony; the state of hemodynamic shock before the operation; lack of blood
transfusion. The maternal death rate was 21.33%. Conclusion: Obstetric
hysterectomy is a very mutilating and complicated surgical procedure and is
still common practice in Africa. The maternal prognosis is still reserved with
a very high mortality rate in Togo.