Clinical governance of hysterectomies in a rural tertiary health care centre

Background: Hysterectomy remains one of the most performed gynecological surgeries worldwide. Despite the availability of medical therapy and minimally invasive procedures, hysterectomy continues to be widely practiced, particularly among rural women. Understanding the clinical determinants influencing hysterectomy and evaluating the adequacy of prior conservative treatment is essential for improving gynaecological care. Objectives were to assess the clinical and sociodemographic factors influencing hysterectomy and to evaluate the provision and adequacy of conservative management prior to surgery in a rural tertiary care setting. Methods: This hospital-based cross-sectional analytical study included 200 women who underwent hysterectomy at MGIMS Sewagram, Maharashtra during the study period. Data were obtained from medical records and included sociodemographic characteristics, presenting symptoms, uterine size, menopausal status, histopathological findings, type of hysterectomy, oophorectomy status, and prior conservative management. Results: Most women were aged 40-50 years (66.0%) and multiparous (76.0%), with 91.0% residing in rural areas. Abnormal uterine bleeding was the most common presenting symptom (40.1%). Leiomyoma was the predominant histopathological finding (41.5%). Abdominal hysterectomy was the most frequently performed procedure (66.0%). Only 49.0% of women received conservative management prior to surgery, of whom just 18.0% received treatment for more than six months, indicating limited adequacy of medical therapy. Conclusions: Hysterectomy in this rural population was performed for benign gynecological conditions, with inadequate utilisation of conservative treatment in many cases. Strengthening early diagnosis, ensuring adequate trials of medical therapy and expanding access to minimally invasive approaches may help reduce potentially avoidable hysterectomies.