EMERGENCY HYSTERECTOMY DUE TO POSTPARTUM HAEMORRHAGE: A GYNAEO-CLINICAL AND COMMUNITY MEDICINE PERSPECTIVE ON RISK AND PSYCHOSOCIAL IMPACT
Main Article Content
Keywords
Postpartum haemorrhage, emergency hysterectomy, maternal complications, psychological impact, fertility loss, Peshawar, obstetric emergency, depression, social stigma
Abstract
Background
PPH is still among the most common causes of maternal morbidity and mortality, especially in resource-poor regions. In extreme scenarios where bleeding continues after medical and conservative surgical measures, emergency peripartum hysterectomy becomes necessary. Although this procedure averts death, it leaves a large burden of grief and psychosocial complications on the women.To assess the clinical risk factors, maternal and neonatal outcomes, and the psychosocial impact of emergency hysterectomy performed for life-threatening PPH at a tertiary care hospital.
Methods
This cross-sectional study was carried out at the Obstetrics and Gynaecology Department of Khyber Teaching Hospital Peshawar from January 2022 to January 2023. 83 women who underwent emergency hysterectomy for post partumhemorrhage (PPH) were included in the study. Data was gathered regarding demographic details, obstetric history, clinical assessment, and postoperative results. The impact from a psychological and social perspective was conducted through interviews. Relationships between chosen variables and outcomes were evaluated using the chi-square test with a significance level of p < 0.05.
Results
the majority of participants were aged 20–29 years, multiparous, and from low-income backgrounds. Uterine atony and placenta accreta were the most common causes of PPH. Cesarean delivery was the predominant mode of birth, and nearly half of the women required ICU admission. Maternal complications included shock (22%), DIC (11%), and sepsis (10%), with a mortality rate of 3.6%. Psychologically, 40% experienced depression, 50% reported anxiety, and 30% had symptoms suggestive of PTSD. Depression was significantly associated with age and employment status (p < 0.05). One in five women reported not being fully informed before surgery, and over 15% experienced marital separation following the procedure.
Conclusion
Emergency hysterectomy is a life-saving measure for severe PPH but carries substantial emotional and social consequences. Greater emphasis is needed on early risk detection, improved antenatal care, and psychosocial support following surgery. Ensuring informed consent and emotional counseling, even during emergencies, should be integral to maternal health services.
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Dr. Sadia Nasir
Assistant Professor, Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, Peshawar, Pakistan
Dr. Syeda Luba Hussain
Assistant Professor, Department of Community Medicine, Watim Medical College, Rawalpindi, Pakistan
Dr. Nusrat fozia Pathan
Associate Professor, Department of Obstetrics and Gynaecology, Khairpur Medical College, Khairpur Mir's, Pakistan
Dr. Maria Nazar
Demonstrator, Department of Community Medicine, Nawaz Sharif Medical College, Gujrat, Pakistan
Dr. Seema Ashraf
Associate Professor, Department of Community Medicine and Public Health, Rehman Medical College, Peshawar, Pakistan
Dr. Isma Rauf
Assistant Professor, Department of Obstetrics and Gynaecology, Women Medical College, Abbottabad, Pakistan