Obstetrical Hysterectomy In Scarred Uterus Versus Unscarred Uterus At Tertiary Care Hospital

Abstract

Background: Obstetrical hysterectomy is a commonly observed in both scarred and unscarred uterus.

Objectives: To compare complications of obstetrical hysterectomies in scarred versus unscarred uterus.

Methodology: A retrospective observational study using non-probability convenient sampling was done at Gyne and Obstetric unit of Abbasi Shaheed Hospital Karachi from January 2019 to December 2021. Pregnant females undergoing obstetrical hysterectomy due to complications associated with previous cesarean scar were included while pregnant females with life threatening obstetrical emergency surgery managed successfully and where uterus was conserved through conservative or surgical methods were excluded. SPSS v23.0 was used for data analysis with chi-square test applied keeping p<0.05 as statistically significant.

Results: Mean age was 31 ± 4.74 years, gestational age 35.24 ± 3.88 weeks, parity 4.93 ± 2.58,. Previous rupture of scar was reported in 20 (17.24 %), previous placenta accrete in 44 (37.93 %), uterine rupture in 18 (15.51 %), PPH atony in 16 (13.79 %), secondary PPH in 12 (10.34 %), obstructed labor and PPH D/C in 04 (3.45 %). 64 (55.2 %) had scarred uterus while 56 (44.8 %) unscarred uterus. Among scarred uterus, 44 had placenta accrete, 04 broad ligament hematoma and scar ectopic and 12 extension of uterine incision scar rupture. 16 females in unscarred uterus groups had uterine rupture during labor while 24 had PPH and 12 endometritis and secondary PPH (p<0.001)

Conclusion: Higher frequencies of scarred uterus reported with placenta accrete being most commonly observed complication. In unscarred uterus females, PPH was reported to be most frequent complication.