Year: 2025 | Month: October-December | Volume: 10 | Issue: 4 | Pages: 48-54
DOI: https://doi.org/10.52403/ijshr.20250408
Elective versus Emergency Obstetric Hysterectomy: A Prospective Comparative Observational Study from a Tertiary Care Center in North India
Kanupriya Verma1, Satinder Pal Kaur2, Tarvinderjit Khurana3, Deepshikha Verma4, Parneet Kaur5
1Senior Resident, Obstetrics & Gynaecology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana
2Professor, Obstetrics & Gynaecology, Government Medical College, Patiala, Punjab
3Associate Professor, Internal Medicine, Adesh Medical College & Hospital, Mohri, Tehsil Shahbad, near Ambala Cantt, Kurukshetra, Haryana
4Senior Resident, Anesthesiology, Maharaja Agrasen Medical College, Agroha, Hisar, Haryana
5Professor & HOD, Obstetrics & Gynaecology, Government Medical College, Patiala, Punjab
Corresponding Author: Satinder Pal Kaur
ABSTRACT
Background and Objectives: Obstetric hysterectomy (OH) is a life-saving surgical procedure performed for catastrophic obstetric complications such as placenta accreta spectrum (PAS), postpartum hemorrhage (PPH), and uterine rupture. Outcomes differ significantly depending on whether the procedure is elective (planned) or emergency (unplanned). This study aimed to compare the indications, perioperative variables, and maternal outcomes of elective versus emergency OH at tertiary referral center in North India.
Methods: A prospective, comparative, observational study was conducted at Government Medical College and Rajindra Hospital, Patiala, from February 2023 to January 2024. All women undergoing OH following both caesarean & vaginal deliveries, mid-trimester and within 42 days of delivery or termination of pregnancy were included. Demographic, clinical, anaesthetic, intra-operative, & post-operative details were recorded. Statistical analysis was performed using appropriate tests, with p <0.05 considered significant.
Results: A total of 37 women underwent OH during the study period. PAS was the most common indication (62.2%), observed more frequently in elective cases (15 vs. 8, p = 0.017). Intractable PPH & uterine rupture were predominantly associated with emergency procedures. Emergency OH was linked to higher intraoperative blood loss, greater need for total blood & blood products (145 vs. 199, p = 0.007) & ICU admission (10 vs. 4, p = 0.091), increased inotropic requirements (13 vs. 6, p = 0.071), & more postoperative complications compared with elective OH. Maternal mortality was also higher in emergencies (4 vs. 1, p = 0.340).
Conclusions: Emergency OH, though linked with higher morbidity and mortality, remains a crucial life-saving procedure in catastrophic situations like uncontrolled hemorrhage or uterine rupture. Elective OH allows better preparedness and improved outcomes, but strengthening antenatal care and referral pathways while maintaining readiness for emergencies is vital to optimize maternal safety.
Keywords: Obstetric hysterectomy; Placenta accreta spectrum; Postpartum hemorrhage; Elective surgery; Emergency surgery; Maternal morbidity; Maternal mortality