Determinants of Emergency Obstetrics Hysterectomy in Ayder Comprehensive Specialized Hospital Five Years data: A case-control study.
Keywords:
Emergency obstetric hysterectomy, case-control, determinants, EthiopiaAbstract
Background: Emergency obstetrics hysterectomy refers to the surgical removal of the uterus either at the time of delivery or within a post-partum period to avert maternal death in case of severe hemorrhage. This life-saving obstetrics management has been used for over 100 years. The incidence of EOH is 2.8 per 1000 in low-income countries compared to 0.7 per 1000 in high-income countries. This study aimed to identify determinants of emergency obstetric hysterectomy at Ayder Comprehensive Specialized Hospital for five years from 1 October 2013 to 30 September 2017.
Methods: A public hospital-based, unmatched case-control study was conducted on 220 cards (55 cases and 165 controls) over five years (1 October 2013 to 30 September 2017). A simple random sampling method was used to select study subjects. Two trained data collectors collected data. EPI-Info version 3.5.1 was used for data entry and cleaning before being transferred to SPSS version 20.0 for analysis. The odds ratio is used in bivariate and multivariate logistic regression to evaluate the statistical relationship between dependent and independent variables; a 95% CI and P value <0.05 were used to test for statistical significance. in the bivariate logistic regression analysis, factors with a P value <0.05 level were considered statistically significant.
Result: Determinants significantly associated with emergency obstetrics hysterectomy were parity ≥5 (AOR = 4.218 (1.804-9.861), 95% CI), uterine rupture (AOR = 19.816 (6.186-63.472), 95% CI), and uterine atony (AOR = 4.723 (1.71-13), 95% CI). Morbid adherent placenta, antenatal follow-up, and previous cesarean section were also identified as determinants of emergency obstetrics hysterectomy.
Conclusion: In this study, the identified determinants of emergency obstetrics hysterectomy were parity >5, antenatal follow-up, previous cesarean section, morbid adherent placenta, uterine rupture, and uterine atony. Prevention of obstructed labour and consequently ruptured uterus and uterine atony by using pantograph and antenatal care will reduce emergency obstetrics hysterectomy.
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