Case Series of Obstetric Hysterectomy: Experience from a Tertiary Care Center

doi:10.61336/jccp/25-07-91

Contents

Abstract
Keywords
Introduction
Materials And Methods
Results
Discussion
Conclusion
References

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Case Series | Volume 11 Issue 7 (July, 2025) | Pages 649 - 650

Case Series of Obstetric Hysterectomy: Experience from a Tertiary Care Center

Shahana Chandniwala

Shilpa Ninama

Nidhi Nayak

Assistant Professor in Department of Obstetric and Gynaecology GMERS Medical College and Hospital,Himatnagar

Associate Professor in Department of Obstetric and Gynaecology GMERS Medical College and Hospital, Himatnagar

Assistant Professor in Department of Obstetric and Gynaecology GMERS Medical College and Hospital, Himatnagar.

Under a Creative Commons license

Open Access

DOI : 10.61336/jccp/25-07-91

Received

June 10, 2025

Revised

June 25, 2025

Accepted

July 9, 2025

Published

July 23, 2025

Abstract

Background: Obstetric hysterectomy remains a life-saving yet drastic surgical intervention, often performed in the setting of life-threatening hemorrhage [1]. This case series examines the indications, intraoperative findings, and maternal outcomes associated with obstetric hysterectomy. Objective: To analyze the causes and outcomes of 10 consecutive cases of obstetric hysterectomy in a tertiary care center. Methods: A retrospective analysis of 10 cases of obstetric hysterectomy over a 12-month period was conducted. Patient demographics, indication for hysterectomy, operative findings, complications, and outcomes were reviewed. Results: The most common indications were morbidly adherent placenta (4 cases), uterine rupture (2 cases), traumatic PPH (2 cases), scar ectopic pregnancy (1 case), and atonic PPH (1 case). There was 1 maternal death due to traumatic PPH following vaginal delivery. Conclusion: Morbidly adherent placenta and uterine rupture remain leading causes of obstetric hysterectomy. Antenatal diagnosis and early surgical intervention are critical for improving maternal outcomes.

Keywords

Obstetric hysterectomy

Morbidly adherent placenta

Uterine rupture

Postpartum hemorrhage

Maternal mortality

INTRODUCTION

Obstetric hysterectomy is a rare but necessary procedure undertaken when all other measures to control obstetric hemorrhage fail. With rising cesarean rates, the incidence of abnormal placentation has increased, contributing significantly to hysterectomy cases. This case series highlights ten cases managed with hysterectomy to save maternal life.

MATERIALS AND METHODS

Study Design: Retrospective case series

Setting: Department of Obstetrics and Gynaecology, Tertiary Care Hospital

Duration: July 2024 to June 2025

Inclusion Criteria: All patients who underwent obstetric hysterectomy due to obstetric complications

Data Collected: Age, parity, gestational age, mode of delivery, indication for hysterectomy, operative findings, maternal outcome

RESULTS

Case No.	Diagnosis/Indication	Mode of Delivery	Type of Hysterectomy	Maternal Outcome	Total Blood Products Given	Notes
1	Uterine rupture	LSCS	Total	Recovered	4 PCV + 4 FFP + 4 Platelets	Bilateral internal iliac ligated; ureteric injury managed with ureteroureteric anastomosis and stent
2	Uterine rupture	LSCS	Subtotal	Recovered	6 PCV + 4 FFP + 4 Platelets	—
3	Extended cervical tear with broad ligament hematoma	NVD	Total	Recovered	4 PCV + 4 FFP + 4 PRC	Bilateral internal iliac artery ligated
4	Scar ectopic pregnancy with previous 3 CS	Laparotomy	Total	Recovered	2 PCV	—
5	Previous 2 CS + Placenta previa + Atonic PPH	LSCS	Total	Recovered	3 PCV	—
6	Placenta accreta	LSCS	Total	Recovered	4 PCV + 4 FFP + 4 Platelets	—
7	Placenta increta	LSCS	Total	Recovered	7 PCV + 6 FFP + 6 Platelets	—
8	Placenta increta	LSCS	Total	Recovered	6 PCV + 4 FFP + 4 Platelets	Placenta invaded left broad ligament; right internal iliac artery ligated
9	Placenta percreta	LSCS	Total	Recovered	5 PCV + 4 FFP + 4 PRC	Bladder repair performed
10	Traumatic PPH	NVD	Subtotal	Maternal death	4 PCV + 4 FFP + 4 Platelets	Delivered outside; patient was in shock

A total of 10 obstetric hysterectomies were performed. Blood transfusions were required in all cases, with the volume of blood products ranging from 2 to 7 units of packed red cells, fresh frozen plasma, and platelets. Case 7 required the highest number of transfusions (7 PCV, 6 FFP, 6 platelets). Internal iliac artery ligation was performed in cases with uncontrolled hemorrhage, particularly in cases 1, 3, and 8. Case 1 also involved ureteric injury, requiring ureteroureteric anastomosis with stenting. Case 9, with placenta percreta, required bladder repair due to invasion. There was one maternal death (Case 10) due to traumatic postpartum hemorrhage following a vaginal delivery outside the institution. The patient arrived in hypovolemic shock and succumbed despite resuscitative efforts.

DISCUSSION

Obstetric hysterectomy, though rare, reflects severe maternal morbidity. Risk factors such as prior cesarean section and placenta previa were prevalent in this series [2]. The increasing trend of morbidly adherent placenta underscores the importance of antenatal detection and planned delivery in equipped centers [2,3].

CONCLUSION

Antenatal surveillance, access to tertiary care, and a multidisciplinary approach are essential in reducing complications associated with obstetric hysterectomy [1,2]. Maternal mortality, though uncommon, remains a critical concern in cases of unanticipated traumatic PPH [1].

REFERENCES

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168–86.
Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27. London: RCOG; 2018.
World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO; 2022.

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