Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India.

Objective: The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India.

Design: Retrospective observational and comparative study from single rural tertiary care referral center of western India.

Method: A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH.

Results: Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% ( 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% ( 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%( < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%( < 0.001) and morbidly adherent placenta increases from 7 to 23%( 0.007). ICU admission and ventilator support increases from 54 to 79%( 0.04) and 22% to 70% ( < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% ( 0.5).

Conclusion: Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.