Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study
INTRODUCTION: Emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies.We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. METHODS: an ethically approved retrospe...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The Pan African Medical Journal
2020-10-01
|
| Series: | The Pan African Medical Journal |
| Subjects: | |
| Online Access: |
https://www.panafrican-med-journal.com/content/article/37/106/pdf/106.pdf
|
| _version_ | 1828838425062539264 |
|---|---|
| author | Ben Izizag Bepouka Madone Mandina Jean Robert Makulo Murielle Longokolo Ossam Odio Nadine Mayasi Tresor Pata Godelive Nsangana Felly Tshikangu Donatien Mangala Dupont Maheshe Serge Nkarnkwin Jonathan Muamba Gorby Ndaie Rodrigue Ngwizani Yves Yanga Aliocha Nkodila Hervé Keke Yamin Kokusa Francois Lepira Innocent Kashongwe Marcel Mbula Jean Marie Kayembe Hippolyte Situakibanza |
| author_facet | Ben Izizag Bepouka Madone Mandina Jean Robert Makulo Murielle Longokolo Ossam Odio Nadine Mayasi Tresor Pata Godelive Nsangana Felly Tshikangu Donatien Mangala Dupont Maheshe Serge Nkarnkwin Jonathan Muamba Gorby Ndaie Rodrigue Ngwizani Yves Yanga Aliocha Nkodila Hervé Keke Yamin Kokusa Francois Lepira Innocent Kashongwe Marcel Mbula Jean Marie Kayembe Hippolyte Situakibanza |
| author_sort | Ben Izizag Bepouka |
| collection | DOAJ |
| description | INTRODUCTION: Emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies.We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. METHODS: an ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1st January 2018 to 31st December 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables. RESULTS: there were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH):73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as ‘others **’: two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products. CONCLUSION: emergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team. |
| first_indexed | 2024-12-12T19:02:09Z |
| format | Article |
| id | doaj.art-ddb10476d75f4882a5104e1f56915a2c |
| institution | Directory Open Access Journal |
| issn | 1937-8688 1937-8688 |
| language | English |
| last_indexed | 2024-12-12T19:02:09Z |
| publishDate | 2020-10-01 |
| publisher | The Pan African Medical Journal |
| record_format | Article |
| series | The Pan African Medical Journal |
| spelling | doaj.art-ddb10476d75f4882a5104e1f56915a2c2022-12-22T00:15:04ZengThe Pan African Medical JournalThe Pan African Medical Journal1937-86881937-86882020-10-013710610.11604/pamj.2020.37.106.2539325393Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional studyBen Izizag Bepouka0Madone Mandina1Jean Robert Makulo2Murielle Longokolo3Ossam Odio4Nadine Mayasi5Tresor Pata6Godelive Nsangana7Felly Tshikangu8Donatien Mangala9Dupont Maheshe10Serge Nkarnkwin11Jonathan Muamba12Gorby Ndaie13Rodrigue Ngwizani14Yves Yanga15Aliocha Nkodila16Hervé Keke17Yamin Kokusa18Francois Lepira19Innocent Kashongwe20Marcel Mbula21Jean Marie Kayembe22Hippolyte Situakibanza23 Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Reanimation, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Reanimation, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Vaccinology, World Health Organization, Kinshasa, Democratic Republic of the Congo Department of Epidemiology, Ministry of Health, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Pneumology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Pneumology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo Unit of Infectious Diseases, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo INTRODUCTION: Emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies.We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. METHODS: an ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1st January 2018 to 31st December 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables. RESULTS: there were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH):73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as ‘others **’: two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products. CONCLUSION: emergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team. https://www.panafrican-med-journal.com/content/article/37/106/pdf/106.pdf emergency hysterectomymassive obstetric hemorrhageplacenta previauterine atonyuterine rupture |
| spellingShingle | Ben Izizag Bepouka Madone Mandina Jean Robert Makulo Murielle Longokolo Ossam Odio Nadine Mayasi Tresor Pata Godelive Nsangana Felly Tshikangu Donatien Mangala Dupont Maheshe Serge Nkarnkwin Jonathan Muamba Gorby Ndaie Rodrigue Ngwizani Yves Yanga Aliocha Nkodila Hervé Keke Yamin Kokusa Francois Lepira Innocent Kashongwe Marcel Mbula Jean Marie Kayembe Hippolyte Situakibanza Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study The Pan African Medical Journal emergency hysterectomy massive obstetric hemorrhage placenta previa uterine atony uterine rupture |
| title | Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study |
| title_full | Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study |
| title_fullStr | Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study |
| title_full_unstemmed | Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study |
| title_short | Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study |
| title_sort | emergency hysterectomy in a tertiary care hospital indications surgical outcomes and challenges a 2 year retrospective descriptive cross sectional study |
| topic | emergency hysterectomy massive obstetric hemorrhage placenta previa uterine atony uterine rupture |
| url |
https://www.panafrican-med-journal.com/content/article/37/106/pdf/106.pdf
|
| work_keys_str_mv | AT benizizagbepouka emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT madonemandina emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT jeanrobertmakulo emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT muriellelongokolo emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT ossamodio emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT nadinemayasi emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT tresorpata emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT godelivensangana emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT fellytshikangu emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT donatienmangala emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT dupontmaheshe emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT sergenkarnkwin emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT jonathanmuamba emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT gorbyndaie emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT rodriguengwizani emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT yvesyanga emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT aliochankodila emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT hervekeke emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT yaminkokusa emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT francoislepira emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT innocentkashongwe emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT marcelmbula emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT jeanmariekayembe emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy AT hippolytesituakibanza emergencyhysterectomyinatertiarycarehospitalindicationssurgicaloutcomesandchallengesa2yearretrospectivedescriptivecrosssectionalstudy |