A Retrospective Study of Cesarean Hysterectomy Cases at a Tertiary Health Care Centre in Bihar

Background: Cesarean hysterectomy is defined as surgical removal of the uterus at the time of Cesarean delivery. It is considered a near miss event and is performed as a last resort to control potentially fatal postpartum hemorrhage. Uterine atony is the most common cause of PPH which accounts for 70%-80% of the cases. With the use of multiple uterotonic drugs and other conservative methods, the need to do hysterectomy in cases of atonic PPH has reduced. Placenta accreta spectrum and uterine rupture are the major contributor to cesarean hysterectomy cases nowadays because of the increasing cesarean section rates. The purpose of this study is to understand the risk factors leading to Cesarean Hysterectomy along with the analysis of the causes, morbidity, mortality and perinatal outcome associated with it. Aim and Objective: To determine the incidence, risk factor and fetomaternal outcome of cesarean hysterectomy cases at PMCH, Patna. Method: A Retrospective observational study was conducted and all the cases of caesarean hysterectomy performed at PMCH, Patna between Jan 2022 and Dec 2023 were studied. Data regarding demographic characteristics, indications, risk factors, complications and perinatal outcome was collected from medical records and the results analysed. Result: Total number of deliveries during the study period was 9032. Total number of caesarean hysterectomy was 78.The incidence of caesarean hysterectomy was 8.6/1000 deliveries. In my study, the most common indication was Ruptured uterus (65.3%) followed by morbidly adhered placenta (15.3%), Placenta previa (12.8%) and atonic PPH (6.4%). Conclusion: Cesarean Hysterectomy is a technically challenging procedure with high complication rates. So, proper antenatal check-up along with close monitoring of high risk pregnancies and institutional delivery is important to curb the high rates of caesarean hysterectomy.