Histopathological findings of hysterectomy specimens in cases of Severe Acute Maternal Morbidity

Abstract

Background: Despite therapeutic advances and a growing perception of the safety of child birth during this century, severe acute maternal morbidity (SAMM) continue to occur in postpartum period in obstetric patients causing life threatening event. The causes of SAMM include; massive obstetrical hemorrhage due to atony, abnormal placentation due to placenta previa, invasive placentation, adherent placenta, retained placenta, uterine inversion, uterine rupture, ruptured ectopic pregnancy, severe hypertension, severe sepsis, thromboembolism and other major organ system dysfunction arising in pregnancy.Material and Methods: The study was conducted at Christian Medical College, Ludhiana over a period of five years from 1st January 2016 to 31st December 2020. All specimens of hysterectomy done for obstetrical indication as a part of life saving procedure to prevent maternal mortality were included. Patient data was retrieved from the medical records and histopathology requisition forms. Gross and microscopic findings were noted and data analysed.Results: There were 25 cases of Emergency Obstetrical Hysterectomy (EOH), most (13,52%) cases presented in 3rd decade of life. Of these, the most common finding was abnormal placentation (56%) of which 4 cases presented with rupture uterus. Following abnormal placentation was rupture uterus (28%) while least common was atonic uterus (16%).Conclusion: EOH is a lifesaving procedure to salvage many near miss- SAMM cases. The histopathological examination of EOH specimens is necessary so as to know its true cause as with the increasing trends of cesarean section and multiple pregnancies, so is the incidence of SAMM increasing. Statistics: It was a descriptive study using averages and proportions for statistical analysis.