10 YEARS EXPERIENCE OF CESAREAN AND POSTPARTUM HYSTERECTOMY IN A TEACHING HOSPITAL IN HONG-KONG

Objective: To review 10 years' experience of obstetric hysterectomy in a university teaching hospital. Study Design: A retrospective study o f all cases of caesarean or postpartum hysterectomy between 1984-1994. Demographic data and clinical details including indications for opera tion, nature of surgical management and complications were analysed. R esults: The incidence of obstetric hysterectomy was 1 in 1420 deliveri es. Overall, 0.32% of caesarean sections and 0.02% of vaginal deliveri es were complicated by emergency obstetric hysterectomy. Morbidly adhe rent placenta (32.7%) was the most common cause of uncontrollable haem orrhage. Prior caesarean delivery and placenta praevia were the main r isk factors for its development. Operative complications included intr a-operative hypotension (33.3%), urinary tract injury (22.2%) and re-e xploration for persistent haemorrhage (12.5%). There was one maternal death due to suspected air embolism. Conclusions: Emergency obstetric hysterectomy, though uncommon, remains a potentially life-saving proce dure which every obstetrician must be familiar with. It is extremely i mportant to have early surgical intervention, prompt resuscitation and management by experienced medical staff to minimise morbidity and mor tality. (C) 1997 Elsevier Science Ireland Ltd.