OUTCOME OF EMERGENCY OBSTATRICS HYSTERECTOMY AND ASSOCIATED FACTORS, IN CHIRO GENERAL HOSPITAL, WEST HARARGE, ETHIOPIA

Abstract

Background Hysterectomy is the removal of the uterus for obstetric or gynecologic emergencies to save the life of mothers. Its outcome may depend on prompt decision making and excellent surgical skills with speedy intervention in addition to associated risk factors which may have direct or indirect effect on hysterectomy outcome. It 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. However, to the knowledge of the investigator there is no previous study done in chiro general hospital with regard to this issue. The objective of this study the aim of this study was to assess maternal outcome of emergency obstetric hysterectomy and its associated factors (from Sep. 11/2012 – Sep 10/2017) in Chiro General Hospital, West Hararge, and Ethiopia. Data was collected from July.15-20 /2018. Methods and Materials Hospital based five years retrospective document review study was conducted from Sep. 11/2012 – Sep 10/2017from registration book, operation log books and patients chart for all mothers underwent hysterectomy in the specified time. Data was collected by using a structured pretested data entry format prepared for this purpose Descriptive statistics, were used to describe the study population in relation to socio demographic and other relevant variables. Bivariate and multivariate analyses were employed to assess the relationship between independent variables and dependent variable at p-value < 0.05 Result There were a total of 11,457 deliveries and 420 cases of hysterectomy during the study period out of which 405 patients had complete charts. The majority of patients 364(89.9%) were form rural area, regarding age distribution 280(69.9%) were above 35yr of age and majority have no ANC follow up from the total hysterectomy done 357(88.1%) .Ruptured uterus 123 (30.4%) atonics PPH 3(7%) and adherent placenta 4(10%) were the commonest causes for emergency hysterectomy while UVP 225(55.6%) myoma 30(7.4%) and tumors 20(4.9%) were found to be the commonest indication of elective hysterectomy. Out of a total hysterectomies performed, majority 288 (71.1%) were total hysterectomies. Age of mother >35 years was significantly associated with increased risk of poor outcome of Hysterectomy with AOR=5.882 (95% CI: 4.00, 15.45). Type of Hysterectomy was also found XIII significantly associated with poor outcome that those with total Hysterectomy had 7 times AOR=7.14 with (95%CI: 6.35,16.22) risk of death than with sub-total hysterectomy. Conclusion and Recommendation The incidence of hysterectomy and maternal death in chiro general hospital was high. Good obstetric 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.