Emergency Obstetric Hysterectomy, The Histopathological Perspective: A Cross-Sectional Study From A Tertiary Care Hospital

IntroductionEmergency obstetric hysterectomy (EOH) is a life-saving procedure which involves the surgical removal of uterus and is usually performed for uncontrollable maternal hemorrhage when all other conservative management has failed. This study was conducted to evaluate the histopathological findings in the EOH specimen received in the department of pathology.MethodsThis hospital-based cross-sectional study was conducted in the Histopathology Laboratory, Department of Pathology, and Dow Medical College (DMC) from September 2017 to December 2018. The histopathological findings in the EOH specimen were recorded and data was analyzed.ResultsNinety-six cases of EOH were received. The incidence of emergency obstetric hysterectomy was 58.37/10,000 deliveries. The mean age of patients was 30.59 years (range 20-45 years). The main histopathological findings were placenta accreta spectrum in 61 (63.54%) cases, cervical tear in eight (8.33%), uterine rupture in seven (7.29%) and endomyometritis in six (6.25%) cases. In the placenta accreta spectrum, placenta accreta was the most frequent diagnosis in 23 (23.96%) of cases, placenta increta in 17 (17.71%), placenta percreta in 10 (10.42%) cases. Seven (7.29%) cases of placenta percreta and four (4.17%) cases of placenta accreta were diagnosed in association with placenta previa. Twenty placentas were received with the hysterectomies, of these eight (40%) placentas showed infarction and six (30%) had intervillous fibrin, both findings were suggestive of uteroplacental insufficiency, while three (15%) placentas had normal histology. Ovaries were received with the hysterectomies in 11 (11.46%) cases. Mature cystic teratoma was diagnosed in two (2.08%) ovaries while the majority of ovaries were normal on histology.ConclusionPlacenta accreta spectrum is the leading histopathological finding in the EOH specimen. Regular antenatal follow-up and radiological examination of pregnant women is inferred to prevent obstetric complications and near-miss event of EOH. Further research is recommended to confirm the findings in placenta. Ovarian conservation is suggested in patients undergoing EOH with no clinical and surgical indication for oophorectomy.