Fetomaternal Outcomes of Emergency Obstetric Hysterectomy in a Tertiary Care Teaching Hospital in Eastern India: A Prospective Observational Study

Abstract

Background: Emergency obstetric hysterectomy (EOH) is a life-saving surgical procedure undertaken when catastrophic obstetric hemorrhage fails to respond to conservative management. Despite improvements in obstetric care, EOH continues to be necessary in many low-resource settings due to high-risk pregnancies, delayed referrals, and rising incidence of placenta accreta spectrum disorders.

Objective: To evaluate the fetomaternal outcomes of emergency obstetric hysterectomy in a tertiary care teaching hospital in eastern India and identify key indications, risk factors, and postoperative complications.

Methods: This prospective observational study was conducted over 11 months at DMCH, Darbhanga, including 125 women who underwent EOH for obstetric indications. Maternal demographic characteristics, obstetric history, indications for hysterectomy, intraoperative details, transfusion requirements, and postoperative complications were recorded. Fetal and maternal outcomes were assessed. Data were analyzed using descriptive statistics and chi-square tests, with p <0.05 considered statistically significant.

Results: The most common indications for EOH were atonic postpartum hemorrhage (35.2%), placenta accreta spectrum (28.8%), uterine rupture (22.4%), and morbid adherent placenta (13.6%). Total hysterectomy was performed in 82.4% of cases. Massive transfusion (>4 units PRBC) was required in 40.8%. Major maternal complications included fever (24.8%), wound infection (18.4%), postoperative shock (14.4%), and DIC (6.4%). Maternal mortality was 7.2%, primarily due to hemorrhagic shock and multiorgan dysfunction. Perinatal mortality was 22.4% and was significantly associated with uterine rupture and severe placental pathology.

Conclusion: EOH remains crucial for the prevention of maternal mortality in severe obstetric emergencies. Timely referral, early recognition of high-risk conditions, and rapid multidisciplinary management are essential for improving fetomaternal outcomes in resource-limited tertiary care settings.

Keywords: EOH, DIC, PRBC