Cesarean Hysterectomy: A Retrospective Study on Incidence and Outcomes at Tertiary Care Hospital in Bangladesh

Background: Cesarean hysterectomy (CH) is a rare but life-saving procedure for uncontrolled obstetric hemorrhage, most frequently associated with placenta accreta spectrum (PAS). Rising cesarean rates have increased PAS incidence worldwide, yet data from Bangladesh remain limited.Objective: To determine the incidence and outcomes of CH in a tertiary care hospital in Bangladesh.Methods: This retrospective observational study was conducted at Ad-din Women’s Medical College Hospital from January 1 to December 31, 2024. All lower uterine segment cesarean sections (LUCS) were reviewed, and CH cases were identified. Maternal demographics, obstetric history, antenatal comorbidities, intraoperative findings, complications, and neonatal outcomes were recorded. Descriptive statistics were applied.Result: Of 12,740 LUCS, 79 required CH (0.62%). Mean maternal age was 29.41 years; 34 (43%) were aged 26–30 years. Preterm delivery occurred in 44 (55.7%). PAS disorders were the leading indications: placenta increta 34 (43%), percreta 21 (27%), and accreta 17 (21%). Uterine rupture accounted for 7 (9%). Gestational diabetes was the most frequent antenatal comorbidity (18.9%). Intraoperative blood transfusion was required in 79 (100%), and 31 (39.2%) required ICU admission. Postoperative complications included urinary tract infection 19 (24.1%), surgical site infection 9 (11.4%), bladder injury 5 (6.3%), and disseminated intravascular coagulation 3 (3.8%). One maternal death (11.3%) occurred due to massive hemorrhage. Neonatal outcomes revealed 30 (38%) low birth weight, 4 (5%) intrauterine death, and 7 (8.9%) NICU admission.Conclusion: CH was uncommon (0.62%) but carried significant maternal and neonatal morbidity. PAS was the predominant indication, reflecting the effect of prior cesarean deliveries. High transfusion rates and ICU needs highlight the importance of antenatal risk stratification, surgical preparedness, and multidisciplinary team involvement. Strengthening early diagnosis of PAS and ensuring adequate blood bank and critical care resources may improve outcomes in high-risk obstetric populations. The Journal of Ad-din Women's Medical College; Vol. 14(2), July 2026; p 11-16