Publication:

A retrospective analysis of emergency obstetric hysterectomy in a rural tertiary care centre in Northern India: incidence, indications, fetomaternal outcomes and challenges

Background Emergency obstetric hysterectomy (EOH) is a life-saving procedure performed in cases of uncontrolled obstetric hemorrhage when conservative measures fail. Despite advances in obstetric care, it remains associated with significant maternal and perinatal morbidity. To evaluate the incidence, indications, risk factors and maternal–neonatal outcomes associated with emergency obstetric hysterectomy.

Methods This retrospective analytical study included all patients undergoing EOH between January 2020 and December 2024 at a tertiary care center. Data were analyzed for demographic variables, indications, surgical details, transfusion requirements, complications and outcomes.

Results The incidence of EOH was 0.212% (52/24,441 deliveries). Most patients were aged 25–34 years (63.5%) and multiparous (88.5%). The leading indications were uterine rupture (30.8%), atonic postpartum hemorrhage (25%) and placenta accreta spectrum (19.2%). Cesarean hysterectomy constituted 65% of cases. ICU admission was required in 80.76% of patients. Maternal mortality was 11.5%. Neonatal survival rate was 61.5%, with poor outcomes mainly in rupture uterus cases.

Conclusions EOH remains a critical intervention in obstetric emergencies. Uterine rupture and hemorrhage are still predominant indications in developing settings. Strengthening early referral systems and improving obstetric care can reduce associated morbidity and mortality.