Repeat Cesarean Section: A Major Risk Factor for Peripartum Hysterectomy.

Background: The overall annual incidence of caesarean delivery in Pakistan has been steadily rising over the past two decades from 14% in 2012-13 to 22% in 2017-18. Primary caesarean often leads to repeat caesareans, which may result in increased chances of morbid adherence of placenta. Now it has become proportionally a major cause of maternal morbidity and mortality. Objective: To determine the frequency, major indication of surgery, mortality and morbidities associated with obstetric hysterectomies at a tertiary care hospital. Study type settings & duration: The retrospective descriptive study was conducted in Gynaecology and Obstetrics unit I of Jinnah Hospital Lahore over a period of four years from January 2016 to December 2019. All cases of obstetric hysterectomy during this time were included in this study. Methodology: Medical records of all pregnant admitted patients for delivery requiring an emergency peripartum hysterectomy (EPH) were included. All files were reviewed for key variables to be evaluated. Each case record was studied in detail for variables like indications, maternal profile, type of operation performed, maternal morbidity and mortality. The data was analyzed using SPSS version 21.0 and data was presented as frequencies and percentages. Results: A total of 96 women underwent obstetric hysterectomy during study period. Out of these 60% had morbid adherence of placenta making it the commonest indication of hysterectomy. Women with previous cesarean section had higher risk of obstetric hysterectomy (73%) than those who had vaginal delivery (27%). Highest incidence found among grand multigravidas, in age group of 30-39 years. Conclusion: Morbidly adherent placenta is one of the leading causes of obstetric hysterectomy. Rising caesarean section rate is one of the major risk factor for surgery. Incidence of cesarean section can only be reduced by health education, provision of quality antenatal care, early referral of high-risk cases and implementation of evidence-based guidelines. [ABSTRACT FROM AUTHOR]