Women’s Lived Experience with Hysterectomy secondary to uterine prolapse and uterine rupture at Gedeo zone, Ethiopia. A phenomenological qualitative study

Women’s Lived Experience with Hysterectomy secondary to uterine prolapse and uterine rupture at Gedeo zone, Ethiopia. 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A phenomenological qualitative study Etaferaw Bekele, Gedefa Amenu, Tesfaye Temesgen, Tesfanew Bekele, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5324393/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 4 You are reading this latest preprint version Abstract Background Uterine rupture is a life-threatening obstetric emergency requiring immediate medical intervention to prevent maternal death or severe morbidity. Hysterectomy, often performed in response to uterine rupture and uterovaginal prolapse, is the most common gynecologic surgery in such cases. This study aimed to explore the lived experiences of women who underwent hysterectomy secondary to uterine rupture and uterovaginal prolapse. Methodology: A phenomenological qualitative study was conducted among hysterectomized women at Dilla University Referral Hospital in 2020. Using purposive sampling, data were collected through structured in-depth interviews, supplemented by field notes, and audio recordings. A manual thematic analysis was employed to examine the data, and findings were presented in both text and table form. Results Thirteen women participated in the study, sharing their post-hysterectomy experiences due to uterine rupture and uterovaginal prolapse. Their narratives were categorized into three key themes: ( 1 ) limitations in daily activities, ( 2 ) reproductive and sexual health concerns, and ( 3 ) psychosocial burdens from societal and familial expectations. Common challenges included pain during movement, inability to lift heavy objects, anxiety about infertility, and significant psychological and social distress. Conclusion Women who undergo hysterectomy due to uterine rupture and prolapse face significant physical, reproductive, and emotional challenges. Comprehensive post-surgical care and support are crucial. Addressing these needs can improve their quality of life. Hysterectomy Uterine rupture Utero-vaginal prolapse lived experience Introduction Uterine rupture is a life-threatening obstetric emergency, often resulting from delays in accessing essential obstetric care. Immediate medical intervention is crucial to prevent maternal death or severe morbidity, commonly referred to as maternal near miss ( 1 ). he organs within the female pelvis, including the uterus, bladder, and rectum, are supported by ligaments and muscles known as the pelvic floor. When these structures weaken, pelvic organs can prolapse into the vagina, a condition known as pelvic organ prolapse. Severe cases may even extend outside the vaginal canal ( 3 ). Hysterectomy, the surgical removal of the uterus, is a common procedure for managing uterine rupture, uterine prolapse, and other gynaecological issues. The surgery can be performed in three main ways: partial (removal of the uterus only), total (removal of both the uterus and cervix), and radical (removal of the uterus, cervix, and part of the vagina) ( 2 , 3 ). While essential for preventing maternal mortality, especially during emergency obstetric haemorrhage, hysterectomy has faced scrutiny due to its short- and long-term complications, including pelvic pain, reduced sexual function, urinary symptoms, and psychological distress ( 4 , 5 – 6 ). Women undergoing hysterectomy often experience physical, psychological, and social challenges, necessitating comprehensive support ( 7 ). These challenges encompass doubts and justifications, pain, embodiment, and a sense of bitternes ( 8 , 9 ). Hysterectomy for placenta accrete spectrum (PAS) has been linked to negative health outcomes and quality of life issues, such as re-hospitalization, painful intercourse, and persistent anxiety at six months postpartum. However, these effects may diminish after one or two years ( 5 , 10 ). Research highlights a twofold increase in maternal mortality associated with delayed access to quality care, communication issues between health services, and a lack of essential medical supplies ( 12 ). In Ethiopia, studies have shown a maternal near-miss ratio of 92.1 per 1,000 live births, with severe postpartum haemorrhage (50.6%) and sepsis (23.4%) as leading causes of critical conditions ( 12 , 13 ). Study in Ethiopia on maternal near miss showed MNM ratio of 92.1 per 1000 live births ( 10 ). Uterine rupture is particularly prevalent in developing regions like Africa, Asia, and Latin America due to inadequate access to essential obstetric care ( 11 ). Hysterectomy, while lifesaving in cases of uterine rupture, is associated with complications, including infections (ranging from 9.0% in laparoscopic hysterectomies to 13.0% in vaginal hysterectomies), venous thromboembolism (1%-12%), and injuries to the genitourinary and gastrointestinal tracts ( 14 , 15 ). Pelvic organ prolapse is also common, particularly among older women, with a significant number requiring surgery by age 80 ( 3 ). Despite the high incidence of uterine rupture and hysterectomy in Ethiopia, there is limited research on the lived experiences of women post-hysterectomy. This study aims to explore these experiences among women in the Gedeo Zone, offering insights that could inform better care practices. Methodology Study area and Period The study will take place in the Gedeo Zone, a densely populated region in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. Established in 1987, Gedeo Zone covers an area of 1,347 km², located between the Abaya Lake to the west and mountains reaching 3,200 meters above sea level to the east. This hilly terrain hosts over 1.5 million people, making it the most densely populated zone in SNNPR. Gedeo is bordered by the Sidama Region to the north and the Oromia region on all other sides. The zone is known for its sustainable agro-forestry system and rich biodiversity, supporting a population density of over 1,300 people per km² ( 16 ). Gedeo Zone comprises eight woredas and four city administrations, with a total population of 1,086,768 (49% male and 51% female) spread across 1,210.89 square kilometers. The zone includes 164 kebeles 31 urban and 133 rural with 276 health facilities, including one referral hospital, three district hospitals, 38 health centers, 146 health posts, and several private and NGO clinics. Dilla University Referral Hospital, along with other district hospitals, offers comprehensive obstetric and surgical services. The study will be conducted from February 1, 2022, to August 30, 2022. Theoretical framework This study will explore the lived experiences of women post-hysterectomy for uterine rupture and uterovaginal prolapse (UVP). The framework is adapted from the WHO definition of maternal near miss, which represents a critical point between health and death where women experience severe, life-threatening obstetric complications but survive. These survivors may face long-term physical, psychological, and social challenges ( 1 , 18 ). The WHO's maternal near-miss tool, which includes clinical signs, management practices, and organ dysfunction indicators, will guide the analysis. The study is also informed by the WHO's broader definition of health as a state of complete physical, social, psychological, and spiritual well-being, not merely the absence of disease ( 17 , 18 ). Study design Phenomenological qualitative study design was used to explore women’s lived experience after hysterectomy from uterine rupture and Uterovaginal prolapsed. Population Women beyond six months and longer after hysterectomy indicated from uterine rupture and Uterovaginal prolapse were recruited to the study. Sample size determination The number of participants who were accessed to be involved in-depth interview was determined by bulk of information obtained from study participants. Data collection was continued until data saturation (no new information) obtained from study participants. Sampling procedure Purposive sampling technique was used to include the potential study participants for this study. The obstetric registration was used to identify the women who underwent hysterectomy for uterine rupture, and then medical document was reviewed to obtain contact address including phone number and district of study participants. Data collection instrument and procedure The interview guide was adopted ( 19 , 20 ), then modified and refined through a thorough literature review by the principal investigator and co-investigators. The guide was translated into Amharic and Gede’uffa with forward and backward translation. It includes flexible questions on personal characteristics, pregnancy and childbirth history, circumstances of uterine rupture, the overall impact of hysterectomy on health (physical, psychological, spiritual, and social well-being), social relationships, livelihood, and coping mechanisms. To ensure appropriateness and community acceptability, a social and behavioural science expert evaluated the questions. Participant recruitment and data collection Potential participants, women who had undergone a hysterectomy following uterine rupture, were identified through medical records and contacted by phone. In-depth structured interviews were conducted, allowing participants to freely express their experiences. Two MSc/MPH data collectors and one supervisor were recruited, and received two days of training on the study’s objectives, data collection methods, and the interview tools. Interviews were recorded using a tape recorder and field notes, with responses recorded verbatim. Rigor and Trustworthiness of Data To ensure data trustworthiness, the research team provided two days of training on data collection procedures. The interview questions were reviewed for consistency and relevance by all co-investigators. The principal investigator and supervisors checked the completeness of field notes and audio recordings. The data were transcribed into English and carefully reviewed by all authors to ensure accuracy. Credibility Credibility was established through triangulation, prolonged engagement, member checks, and the search for negative cases. Researchers collaborated to improve the quality of identified themes. Confirmability Confirmability was promoted by having investigators review each other's results, ensuring that the findings accurately represented participants’ voices. During interviews, participants were asked to clarify any questions, further supporting the validity of the data. Transferability and dependability Transferability was enhanced by including participants of different ages and backgrounds, while acknowledging the study’s sample limitations. Dependability was ensured through consistent application of the data collection tool, with no inconsistencies found in the data, indicating that the results are replicable. Data processing and analysis Audio recordings were transcribed verbatim and translated into English for thematic analysis. Codes were grouped into families and organized by themes for report writing. Thematic analysis was achieved through consensus among investigators, who reviewed and discussed the most prevalent perspectives. Logical reasoning and structured analytical techniques were used to identify errors during data transcription, cleaning, and analysis. Ethical Considerations Ethical clearance was obtained from the research board of Dilla University (ethical code: duirb/32/22 − 01). Participants were informed of the study's purpose, assured of confidentiality, and their personal information was protected through coding. Informed consent was obtained, with participants signing the interview guide cover page upon agreeing to participate. Result Sociodemographic status of participants Thirteen hysterectomies women had been interviewed during this study. All of them were operated at Dilla Referral Hospital where obstetricians and gynaecologists are found. Majority (46.2%) of women were between the age of 36-45 years and married (76.9%), Table 1 . Table 1 : Sociodemographic characteristics. Variables Participants Frequency (N =13) Percentage (%) Sex Females 13 100 Age group 46 0 0 Level of education Illiterate 4 30.7 Primary school complete 4 30.7 High school complete 2 15.3 College diploma 1 7.6 Higher education graduate 1 7.6 Marital status Married 10 76.9 Single 0 0 Divorced 3 23.0 Widowed 0 0 Working status Home mother and Farmer 9 69.23 Governmental employed 3 23.0 NGO employed 1 7.6 Economic status Low income 13 100 Medium income 0 0 Higher income 0 0 Identified themes of women who had hysterectomies The researchers read through all the transcribed data to identify the common themes. Three major themes were identified. This includes Limited working activity, reproductive and sexual problems, and Social and psychological changes as shown in, Table 2 . Table 2 : Thematic representation of the participants response, Dilla, Ethiopia, 2023 (n=13). Theme Subtheme 1. Limited working activity 1.1. Difficulty of lifting objects 1.2. Difficulty of working in farms 1.3. Unable to have smooth movement 2. Reproductive and sexual problems 2.1. Unable to become pregnant 2.2. Husband left out 3. Social and psychological changes 3.1. Rumours from neighbours 3.2. Social discrimination 3.3. Social negligence 1. Them one : Limited working activity Many participants explain they had difficulty of lifting heavy objects, working in farms and having smooth movements. This problem has been expressed as it continues for long period of time with different degree of pain during activity. ‘‘ I was operated on in Dilla hospital, and after the operation, the baby was born dead. Following the operation, I couldn’t able to do my work, especially heavy objects because I don’t have the power to do so. But before the procedure, I used to lift heavy objects and work in farming with my husband. So now I do small business as a merchant in a small village. I never experience and feel health problems in my body related to the operation. I don’t have a problem in relationships with family and neighbours following the operation. There is some pain and malaise, currently, I have a problem with weight loss’’ . (Gravida VI, Para V) One of the participants explained as she has difficulty of performing her daily activity to support her family as : ‘‘my current role in the family is doing house works or I’m a housewife. I have a problem of performing my daily activities following the operation. It is hard to raise, teach, and dress those children. I couldn’t help my family as I do before. I give birth to all children in the home; we don’t know those delivery services provided in health centres before. Following the operation, my baby was born dead. I feel discomfort in my body following the procedure.’’ (Gravida VII Para V). 2. Theme two : Social relation related issues Having strong social and family support after hysterectomy was also mentioned repeatedly from the participants: ‘‘there is no problem in my daily social and family relationship. During my return home from the hospital all of them supported and helped to recover fast. Even all my relatives praised God for helping me survive. They all worried and cried during that incident. There is no problem during attending church and other rituals.’’ ( Gravida X Para VII). A woman with hysterectomy due to uterine rupture complains a social negligence and discrimination from the community because of her hysterectomy. One of our participants claimed: ‘I didn’t have antenatal care follow-up. Before the operation l prayed for living till I get adequately recovered, I don’t have information about the removal of the uterus during the operation. I have a problem with my power I face sometimes unable to carry out my daily activities. There is some talking about me from my neighbours regarding the operation and they talk about my feature lack of chance to give birth. They also exclude me from different social gatherings like ‘‘edir’’, and religious meetings’’. (Gravidity III, Para III mother) 3. Theme three : Fertility related issues Some participants claimed that losing their fertility after uterine surgery created discomfort and become hopeless for their future life. Many of the participants became emotionally dependent on their number of children. Some participants said: ‘‘During my pregnancy, I don’t have a problem. I do have problems with my previous pregnancies; I give all birth at home. I don’t have information about my loss of fertility, the hospital care providers didn’t explain enough regarding the procedure even my loss of chance of giving birth. This is a big thing still aim to question. I have pain in my abdomen. My relationship with my husband is not changed after the operation but I have pain and discomfort during sexual intercourse. I need to give birth, but I couldn’t, sometime my feeling changes when I think this’’ . (Gravida IV, para II). ‘‘ Before my referral to the hospital, I stayed for more than 24hrs on labour. I took most of my time labouring in home. I feel pain during menstruation, I asked the health centre care provider. I’m aware of the removal of my uterus, they explained that my uterus is going to be removed before the operation and I gave them the will. There is no feeling or problem except the pain around my surgical side during menstruation. I would be happy if I have a chance to get more children specially a boy, because I have one boy only. ’’ (Gravidity V, Parity V) ‘‘I have felt pain sometimes but there are no other problems. I gave birth to all nine children in the home. I have information regarding my infertility or I will not have children anymore, but that is no problem with that because I have already enough children. I have a good relationship with my husband. Nothing changed with him.’’ (Gravida X, para X) Participants also stated that their husbands left them and disappear without any known reason, one of the participants said: ‘Our marriage was good before the incident and operation following that he stayed only two months with me but after that, he left me. I don’t know the matter with him. There is no complicated or severe health problems related to the operation so far. There is no problem during attending church and other rituals.’’ (Gravida X Para IX.) Discussion This study explored the women's experiences after hysterectomy due to uterine rupture and uterovaginal prolapse in the Gedeo zone. Participants stated their lived experiences on their daily activity, reproductive and sexual behaviours, and psychological and social support from society and from their close ones. In this study, many participants expressed they have difficulty of body in their daily activities. They claimed as they faced challenges that inhibit them from addressing their personal activities, pain during mobility and weakness with some movements. This affects their quality of life and economic status of their family. This expression have been stated in another phenomenological study in Palestinian reviled women experienced physical changes that include pain, insomnia, eating disorder and immobility ( 21 ). But some hysterectomized women evaluated their health as ‘’good’’ and 27.14% of women evaluated their health approximately the same as before surgery or felt much better than before surgery ( 22 ). In the current study the concern of future fertility was raised by many of the participants. They feel as life is meaningless without their uterus and unable to have additional children is the difficult of their future life. They fear if they could not give birth their husbands may not be happy and searching for other wife to get additional children from other women. This could be due to having more children are considered as a sign of richness and bravery in this study area. Similar concerns were explained in study conducted in women sexual experience after hysterectomy indicated the improvement in sexuality during intercourse, the surgery freed them from symptoms mostly caused by uterine fibroids, which caused bleeding. In this sense, it can be noticed that the removal of the uterus was intended to restore health, as well as to resume the sexual life, previously compromised ( 20 ). In a study from Uganda, women felt deeply that having no uterus was equivalent to being less of woman, worthless, manly and dismembered, they wondered how one can be a complete woman without getting monthly periods and some said they now feel a deep hole inside their tummies. most of them felt so vulnerable and at the mercy of their husbands, for the first time in their marital lives they felt unsafe and worthless and they were not sure what their husbands were thinking or planning because most of them didn’t want to talk about it ( 23 ). Participants from this study reported that they have good family and societal support and respect. This is due to fear they had on the life of the women; they did not expect the women are alive after hysterectomy. The relatives also expressed mutual love, respect, and care, for the hysterectomized women. This was supported by other study that Women with hysterectomy experience comprehensive support from their family and specially their husband ( 24 ). Some participants from the current study had many social and psychological burdens. They were discriminated from some social gatherings and religious activities. Some individuals consider being hysterectomized and being women without uterus is a punishment from God and a result of sin. In the present study psychologically, they were also depressed and fearful about their future life. In other study psychological changes like depression, accompanied by anxiety, de-socialization, and aggression, and this surgery have adverse effects on body image, self-esteem, and dyadic adjustment in affected women( 21 ). In Palestine depression, followed by anxiety, de-socialization, and aggression, is the most common complication that our study reported ( 25 ). Hysterectomy due to uterovaginal prolapse was also the leading factor for post procedure depression ( 26 ). Strength and limitation This study has many strengths, it tries to explore the lived experience of hysterectomized women in detail qualitatively. It used a direct interview which helps to dig out the real experience of participants. The study has two major limitations. First, this study was based on the experience of hysterectomized women that they want to tell their living status and there may be experiences that they did not want to tell. Second, this study focuses on the experience of hysterectomized women only; it did not take the experience of the close relatives like husband, children and any other close ones. Conclusion Thirteen hysterectomized women had been interviewed during this study. This study explored the women's experiences after hysterectomy due to uterine rupture and uterovaginal prolapse in the Gedeo zone. Participants stated their lived experiences in a different way and finally thermalized into three thematic categories as limitations in daily activity, reproductive and sexual behaviour problems, and psychosocial burdens from society and from their close ones. Pain during movement, unable to lift heavy objects, infertility concerns, psychological, and social discomforts were stated as a predominant problem. Abbreviations DUIRB Dilla University Institutional Review Board KM kilometre NGO Non-governmental Organization PAS Placenta Accrete Spectrum SNNPR Southern Nation Nationalities and Peoples Region UVP : Utro-vaginal Prolapse, WHO World Health Organization. Declarations Ethics approval and consent to participate Ethical clearance was obtained from the research board of Dilla University (ethical code: duirb/32/22 − 01). Informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing of interest We declare that they have no competing interests. Funding This study was funded by Dilla University. Author Contribution EB, GA, TT, TB, and ZF developed the protocol. EB, GA, TT, TB, and ZF conducted the analyses, constructed summary of findings. EB, GA, TT, TB, and ZF drafted the manuscript. DGA drafted and critically reviewed the manuscript. All authors reviewed and edited the manuscript. Acknowledgement We would like to express our gratitude to everyone who have participated in conducting this study. Data Availability All relevant data collected from the study participants will be provided by the corresponding author upon request. References The WHO near. -miss approach for maternal health. Banovcinova L, Jandurova S. Subjective perceptions of life among women, 02009, 2018. Elaine DY, Connor ZZ. Women ’ s experience of living with cervical cancer – A descriptive review. Clarke-pearson DL. Complications Hysterect. 2013;121(3):654–73. Health-Related. 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Open Nurs J. 2020;14(1):74–9. Carroll L, O’ Sullivan C, Doody C, Perrotta C, Fullen B. Pelvic organ prolapse: The lived experience. Laganà AS. editor PLOS ONE. 2022;17(11):e0276788. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 28 Oct, 2024 Editor assigned by journal 24 Oct, 2024 Submission checks completed at journal 24 Oct, 2024 First submitted to journal 24 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5324393","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371412111,"identity":"8af64c03-195e-45ef-8048-b3523f55be0b","order_by":0,"name":"Etaferaw Bekele","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Etaferaw","middleName":"","lastName":"Bekele","suffix":""},{"id":371412112,"identity":"0ff257dd-b477-4e86-9cc5-6f051607d1e6","order_by":1,"name":"Gedefa Amenu","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Gedefa","middleName":"","lastName":"Amenu","suffix":""},{"id":371412113,"identity":"626b0d33-a2c6-41a2-bfd6-3ac1cc21fba3","order_by":2,"name":"Tesfaye Temesgen","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Tesfaye","middleName":"","lastName":"Temesgen","suffix":""},{"id":371412114,"identity":"2eacef13-66af-415b-a86c-15ad0034db13","order_by":3,"name":"Tesfanew Bekele","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Tesfanew","middleName":"","lastName":"Bekele","suffix":""},{"id":371412115,"identity":"ad0a5307-9637-4209-9cd3-4f9fa3e1dd92","order_by":4,"name":"Zerihun Figa","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Zerihun","middleName":"","lastName":"Figa","suffix":""},{"id":371412116,"identity":"0bf2c03c-3b3d-452f-a449-38d4d586b234","order_by":5,"name":"Dawit Getachew Assefa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYDCCA2AEAjwgwgaIGRsPENQCxBJQLWkgLQ0EtTAgaTkMF8QJ+I6fMTz84ZdNHX/72YOPeWrO261tPwy0pcYmGpcWyTM5BgcO9qVJSJzJSzbmOXY7eduZRKCWY2m5DTi0GBzI3XDgYM9hCYYbPGbSOWy3k80OALUwNhzGreX8W5CW/xLyN3jMf+f8O5dsdv4hAS03gLYc+HFAwgBoC3Nu2wE7sxsEbJG88f7DgbMNyZIbz+QYS//tS04wuwG0JQGPX/jOpyV/qPhjxy8HDLqPM77Z2ZudT3/44EONDU4tYMDYhmAnglUm4FMOBn8QTHuCikfBKBgFo2DEAQC/M3E6Cy/eDwAAAABJRU5ErkJggg==","orcid":"","institution":"Dilla University","correspondingAuthor":true,"prefix":"","firstName":"Dawit","middleName":"Getachew","lastName":"Assefa","suffix":""}],"badges":[],"createdAt":"2024-10-24 09:08:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5324393/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5324393/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68252435,"identity":"bb9495a3-0502-42e8-84bc-dec84e80fe87","added_by":"auto","created_at":"2024-11-05 10:22:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":665936,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5324393/v1/7fdaca80-2236-40c8-a7e7-15ece2eef39c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Women’s Lived Experience with Hysterectomy secondary to uterine prolapse and uterine rupture at Gedeo zone, Ethiopia. A phenomenological qualitative study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUterine rupture is a life-threatening obstetric emergency, often resulting from delays in accessing essential obstetric care. Immediate medical intervention is crucial to prevent maternal death or severe morbidity, commonly referred to as maternal near miss (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). he organs within the female pelvis, including the uterus, bladder, and rectum, are supported by ligaments and muscles known as the pelvic floor. When these structures weaken, pelvic organs can prolapse into the vagina, a condition known as pelvic organ prolapse. Severe cases may even extend outside the vaginal canal (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHysterectomy, the surgical removal of the uterus, is a common procedure for managing uterine rupture, uterine prolapse, and other gynaecological issues. The surgery can be performed in three main ways: partial (removal of the uterus only), total (removal of both the uterus and cervix), and radical (removal of the uterus, cervix, and part of the vagina) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While essential for preventing maternal mortality, especially during emergency obstetric haemorrhage, hysterectomy has faced scrutiny due to its short- and long-term complications, including pelvic pain, reduced sexual function, urinary symptoms, and psychological distress (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWomen undergoing hysterectomy often experience physical, psychological, and social challenges, necessitating comprehensive support (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These challenges encompass doubts and justifications, pain, embodiment, and a sense of bitternes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Hysterectomy for placenta accrete spectrum (PAS) has been linked to negative health outcomes and quality of life issues, such as re-hospitalization, painful intercourse, and persistent anxiety at six months postpartum. However, these effects may diminish after one or two years (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch highlights a twofold increase in maternal mortality associated with delayed access to quality care, communication issues between health services, and a lack of essential medical supplies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In Ethiopia, studies have shown a maternal near-miss ratio of 92.1 per 1,000 live births, with severe postpartum haemorrhage (50.6%) and sepsis (23.4%) as leading causes of critical conditions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Study in Ethiopia on maternal near miss showed MNM ratio of 92.1 per 1000 live births (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Uterine rupture is particularly prevalent in developing regions like Africa, Asia, and Latin America due to inadequate access to essential obstetric care (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHysterectomy, while lifesaving in cases of uterine rupture, is associated with complications, including infections (ranging from 9.0% in laparoscopic hysterectomies to 13.0% in vaginal hysterectomies), venous thromboembolism (1%-12%), and injuries to the genitourinary and gastrointestinal tracts (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Pelvic organ prolapse is also common, particularly among older women, with a significant number requiring surgery by age 80 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the high incidence of uterine rupture and hysterectomy in Ethiopia, there is limited research on the lived experiences of women post-hysterectomy. This study aims to explore these experiences among women in the Gedeo Zone, offering insights that could inform better care practices.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and Period\u003c/h2\u003e \u003cp\u003eThe study will take place in the Gedeo Zone, a densely populated region in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. Established in 1987, Gedeo Zone covers an area of 1,347 km², located between the Abaya Lake to the west and mountains reaching 3,200 meters above sea level to the east. This hilly terrain hosts over 1.5\u0026nbsp;million people, making it the most densely populated zone in SNNPR. Gedeo is bordered by the Sidama Region to the north and the Oromia region on all other sides. The zone is known for its sustainable agro-forestry system and rich biodiversity, supporting a population density of over 1,300 people per km² (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGedeo Zone comprises eight woredas and four city administrations, with a total population of 1,086,768 (49% male and 51% female) spread across 1,210.89 square kilometers. The zone includes 164 kebeles 31 urban and 133 rural with 276 health facilities, including one referral hospital, three district hospitals, 38 health centers, 146 health posts, and several private and NGO clinics. Dilla University Referral Hospital, along with other district hospitals, offers comprehensive obstetric and surgical services. The study will be conducted from February 1, 2022, to August 30, 2022.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTheoretical framework\u003c/h3\u003e\n\u003cp\u003eThis study will explore the lived experiences of women post-hysterectomy for uterine rupture and uterovaginal prolapse (UVP). The framework is adapted from the WHO definition of maternal near miss, which represents a critical point between health and death where women experience severe, life-threatening obstetric complications but survive. These survivors may face long-term physical, psychological, and social challenges (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The WHO's maternal near-miss tool, which includes clinical signs, management practices, and organ dysfunction indicators, will guide the analysis. The study is also informed by the WHO's broader definition of health as a state of complete physical, social, psychological, and spiritual well-being, not merely the absence of disease (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003ePhenomenological qualitative study design was used to explore women’s lived experience after hysterectomy from uterine rupture and Uterovaginal prolapsed.\u003c/p\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cp\u003eWomen beyond six months and longer after hysterectomy indicated from uterine rupture and Uterovaginal prolapse were recruited to the study.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe number of participants who were accessed to be involved in-depth interview was determined by bulk of information obtained from study participants. Data collection was continued until data saturation (no new information) obtained from study participants.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSampling procedure\u003c/h2\u003e \u003cp\u003ePurposive sampling technique was used to include the potential study participants for this study. The obstetric registration was used to identify the women who underwent hysterectomy for uterine rupture, and then medical document was reviewed to obtain contact address including phone number and district of study participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection instrument and procedure\u003c/h3\u003e\n\u003cp\u003eThe interview guide was adopted (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), then modified and refined through a thorough literature review by the principal investigator and co-investigators. The guide was translated into Amharic and Gede’uffa with forward and backward translation. It includes flexible questions on personal characteristics, pregnancy and childbirth history, circumstances of uterine rupture, the overall impact of hysterectomy on health (physical, psychological, spiritual, and social well-being), social relationships, livelihood, and coping mechanisms. To ensure appropriateness and community acceptability, a social and behavioural science expert evaluated the questions.\u003c/p\u003e\n\u003ch3\u003eParticipant recruitment and data collection\u003c/h3\u003e\n\u003cp\u003ePotential participants, women who had undergone a hysterectomy following uterine rupture, were identified through medical records and contacted by phone. In-depth structured interviews were conducted, allowing participants to freely express their experiences. Two MSc/MPH data collectors and one supervisor were recruited, and received two days of training on the study’s objectives, data collection methods, and the interview tools. Interviews were recorded using a tape recorder and field notes, with responses recorded verbatim.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRigor and Trustworthiness of Data\u003c/h2\u003e \u003cp\u003eTo ensure data trustworthiness, the research team provided two days of training on data collection procedures. The interview questions were reviewed for consistency and relevance by all co-investigators. The principal investigator and supervisors checked the completeness of field notes and audio recordings. The data were transcribed into English and carefully reviewed by all authors to ensure accuracy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCredibility\u003c/h2\u003e \u003cp\u003eCredibility was established through triangulation, prolonged engagement, member checks, and the search for negative cases. Researchers collaborated to improve the quality of identified themes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eConfirmability\u003c/h2\u003e \u003cp\u003e Confirmability was promoted by having investigators review each other's results, ensuring that the findings accurately represented participants’ voices. During interviews, participants were asked to clarify any questions, further supporting the validity of the data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTransferability and dependability\u003c/h2\u003e \u003cp\u003eTransferability was enhanced by including participants of different ages and backgrounds, while acknowledging the study’s sample limitations. Dependability was ensured through consistent application of the data collection tool, with no inconsistencies found in the data, indicating that the results are replicable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eAudio recordings were transcribed verbatim and translated into English for thematic analysis. Codes were grouped into families and organized by themes for report writing. Thematic analysis was achieved through consensus among investigators, who reviewed and discussed the most prevalent perspectives. Logical reasoning and structured analytical techniques were used to identify errors during data transcription, cleaning, and analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e Ethical clearance was obtained from the research board of Dilla University (ethical code: duirb/32/22 − 01). Participants were informed of the study's purpose, assured of confidentiality, and their personal information was protected through coding. Informed consent was obtained, with participants signing the interview guide cover page upon agreeing to participate.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic status of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThirteen hysterectomies women had been interviewed during this study. All of them were operated at Dilla Referral Hospital where obstetricians and gynaecologists are found. Majority (46.2%) of women were between the age of 36-45 years and married (76.9%),\u0026nbsp;\u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Sociodemographic characteristics.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e(N\u003cstrong\u003e=13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026lt; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e26-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e36-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026gt;46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eIlliterate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003ePrimary school complete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eHigh school complete\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eCollege diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eHigher education graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eDivorced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eWidowed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eHome mother and\u003c/p\u003e\n \u003cp\u003eFarmer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e69.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eGovernmental employed \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eNGO employed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEconomic status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eLow income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eMedium income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eHigher income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIdentified themes of women who had\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ehysterectomies\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers read through all the transcribed data to identify the common themes. Three major themes were identified. This includes Limited working activity, reproductive and sexual problems, and Social and psychological changes as shown in, \u003cstrong\u003eTable 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: Thematic representation of the participants response, Dilla, Ethiopia, 2023 (n=13).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.7009%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.2991%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.7009%;\"\u003e\n \u003cp\u003e1.\u0026nbsp; \u0026nbsp;Limited working activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.2991%;\"\u003e\n \u003cp\u003e1.1.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Difficulty of lifting objects\u003c/p\u003e\n \u003cp\u003e1.2.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Difficulty of working in farms\u003c/p\u003e\n \u003cp\u003e1.3.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Unable to have smooth movement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.7009%;\"\u003e\n \u003cp\u003e2.\u0026nbsp; \u0026nbsp;Reproductive and sexual problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.2991%;\"\u003e\n \u003cp\u003e2.1.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Unable to become pregnant\u003c/p\u003e\n \u003cp\u003e2.2.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Husband left out\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.7009%;\"\u003e\n \u003cp\u003e3.\u0026nbsp; \u0026nbsp;Social and psychological changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.2991%;\"\u003e\n \u003cp\u003e3.1.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Rumours from neighbours\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.2.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Social discrimination\u003c/p\u003e\n \u003cp\u003e3.3.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Social negligence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;\u003cstrong\u003eThem one\u003c/strong\u003e: Limited working activity\u003c/p\u003e\n\u003cp\u003eMany participants explain they had difficulty of lifting heavy objects, working in farms and having smooth movements. This problem has been expressed as it continues for long period of time with different degree of pain during activity. \u0026nbsp;\u0026lsquo;\u0026lsquo;\u003cem\u003eI was operated on in Dilla hospital, and after the operation, the baby was born dead. Following the operation, I couldn\u0026rsquo;t able to do my work, especially heavy objects because I don\u0026rsquo;t have the power to do so. But before the procedure, I used to lift heavy objects and work in farming with my husband. \u0026nbsp;So now I do small business as a merchant in a small village. I never experience and feel health problems in my body related to the operation. \u0026nbsp;I don\u0026rsquo;t have a problem in relationships with family and neighbours following the operation. There is some pain and malaise, currently, I have a problem with weight loss\u0026rsquo;\u0026rsquo;\u003c/em\u003e. (Gravida VI, Para V)\u003c/p\u003e\n\u003cp\u003eOne of the participants explained as she has difficulty of performing her daily activity to support her family as\u003cem\u003e: \u0026lsquo;\u0026lsquo;my current role in the family is doing house works or I\u0026rsquo;m a housewife. I have a problem of performing my daily activities following the operation. It is hard to raise, teach, and dress those children. I couldn\u0026rsquo;t help my family as I do before. \u0026nbsp;I give birth to all children in the home; we don\u0026rsquo;t know those delivery services provided in health centres before. Following the operation, my baby was born dead. I feel discomfort in my body following the procedure.\u0026rsquo;\u0026rsquo;\u003c/em\u003e (Gravida VII Para V).\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;\u003cstrong\u003eTheme two\u003c/strong\u003e: Social relation related issues\u003c/p\u003e\n\u003cp\u003eHaving strong social and family support after hysterectomy was also mentioned repeatedly from the participants:\u003cem\u003e\u0026nbsp;\u0026lsquo;\u0026lsquo;there is no problem in my daily social and family relationship. During my return home from the hospital all of them supported and helped to recover fast. \u0026nbsp; Even all my relatives praised God for helping me survive. They all worried and cried during that incident. There is no problem during attending church and other rituals.\u0026rsquo;\u0026rsquo; (\u003c/em\u003eGravida X Para VII).\u003c/p\u003e\n\u003cp\u003eA woman with hysterectomy due to uterine rupture complains a social negligence and discrimination from the community because of her hysterectomy. One of our participants claimed:\u003cem\u003e\u0026nbsp;\u0026lsquo;I didn\u0026rsquo;t have antenatal care follow-up. Before the operation l prayed for living till I get adequately recovered, I don\u0026rsquo;t have information about the removal of the uterus during the operation. I have a problem with my power I face sometimes unable to carry out my daily activities. There is some talking about me from my neighbours regarding the operation and they talk about my feature lack of chance to give birth. They also exclude me from different social gatherings like \u0026lsquo;\u0026lsquo;edir\u0026rsquo;\u0026rsquo;, and religious meetings\u0026rsquo;\u0026rsquo;.\u003c/em\u003e (Gravidity III, Para III mother)\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;\u003cstrong\u003eTheme three\u003c/strong\u003e: \u003cstrong\u003eFertility related issues\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome participants claimed that losing their fertility after uterine surgery created discomfort and become hopeless for their future life. Many of the participants became emotionally dependent on their number of children. Some participants said:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026lsquo;\u0026lsquo;During my pregnancy, I don\u0026rsquo;t have a problem. I do have problems with my previous pregnancies; I give all birth at home. I don\u0026rsquo;t have information about my loss of fertility, the hospital care providers didn\u0026rsquo;t explain enough regarding the procedure even my loss of chance of giving birth. This is a big thing still aim to question. I have pain in my abdomen. My relationship with my husband is not changed after the operation but I have pain and discomfort during sexual intercourse. I need to give birth, but I couldn\u0026rsquo;t, sometime my feeling changes when I think this\u0026rsquo;\u0026rsquo;\u003c/em\u003e. (Gravida IV, para II).\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;\u0026lsquo;\u003cem\u003eBefore my referral to the hospital, I stayed for more than 24hrs on labour. I took most of my time labouring in home. I feel pain during menstruation, I asked the health centre care provider. I\u0026rsquo;m aware of the removal of my uterus, they explained that my uterus is going to be removed before the operation and I gave them the will. There is no feeling or problem except the pain around my surgical side during menstruation. \u0026nbsp;I would be happy if I have a chance to get more children specially a boy, because I have one boy only.\u003c/em\u003e\u0026rsquo;\u0026rsquo; (Gravidity V, Parity V)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;I have felt pain sometimes but there are no other problems. I gave birth to all nine children in the home. I have information regarding my infertility or I will not have children anymore, but that is no problem with that because I have already enough children. I have a good relationship with my husband. Nothing changed with him.\u0026rsquo;\u0026rsquo;\u003c/em\u003e(Gravida X, para X)\u003c/p\u003e\n\u003cp\u003eParticipants also stated that their husbands left them and disappear without any known reason, one of the participants said:\u003cem\u003e\u0026nbsp;\u0026lsquo;Our marriage was good before the incident and operation following that he stayed only two months with me but after that, he left me. I don\u0026rsquo;t know the matter with him. There is no complicated or severe health problems related to the operation so far. There is no problem during attending church and other rituals.\u0026rsquo;\u0026rsquo;\u003c/em\u003e(Gravida X Para IX.)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the women's experiences after hysterectomy due to uterine rupture and uterovaginal prolapse in the Gedeo zone. Participants stated their lived experiences on their daily activity, reproductive and sexual behaviours, and psychological and social support from society and from their close ones.\u003c/p\u003e \u003cp\u003eIn this study, many participants expressed they have difficulty of body in their daily activities. They claimed as they faced challenges that inhibit them from addressing their personal activities, pain during mobility and weakness with some movements. This affects their quality of life and economic status of their family. This expression have been stated in another phenomenological study in Palestinian reviled women experienced physical changes that include pain, insomnia, eating disorder and immobility (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). But some hysterectomized women evaluated their health as \u0026lsquo;\u0026rsquo;good\u0026rsquo;\u0026rsquo; and 27.14% of women evaluated their health approximately the same as before surgery or felt much better than before surgery (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the current study the concern of future fertility was raised by many of the participants. They feel as life is meaningless without their uterus and unable to have additional children is the difficult of their future life. They fear if they could not give birth their husbands may not be happy and searching for other wife to get additional children from other women. This could be due to having more children are considered as a sign of richness and bravery in this study area. Similar concerns were explained in study conducted in women sexual experience after hysterectomy indicated the improvement in sexuality during intercourse, the surgery freed them from symptoms mostly caused by uterine fibroids, which caused bleeding. In this sense, it can be noticed that the removal of the uterus was intended to restore health, as well as to resume the sexual life, previously compromised (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In a study from Uganda, women felt deeply that having no uterus was equivalent to being less of woman, worthless, manly and dismembered, they wondered how one can be a complete woman without getting monthly periods and some said they now feel a deep hole inside their tummies. most of them felt so vulnerable and at the mercy of their husbands, for the first time in their marital lives they felt unsafe and worthless and they were not sure what their husbands were thinking or planning because most of them didn\u0026rsquo;t want to talk about it (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParticipants from this study reported that they have good family and societal support and respect. This is due to fear they had on the life of the women; they did not expect the women are alive after hysterectomy. The relatives also expressed mutual love, respect, and care, for the hysterectomized women. This was supported by other study that Women with hysterectomy experience comprehensive support from their family and specially their husband (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome participants from the current study had many social and psychological burdens. They were discriminated from some social gatherings and religious activities. Some individuals consider being hysterectomized and being women without uterus is a punishment from God and a result of sin. In the present study psychologically, they were also depressed and fearful about their future life. In other study psychological changes like depression, accompanied by anxiety, de-socialization, and aggression, and this surgery have adverse effects on body image, self-esteem, and dyadic adjustment in affected women(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In Palestine depression, followed by anxiety, de-socialization, and aggression, is the most common complication that our study reported (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Hysterectomy due to uterovaginal prolapse was also the leading factor for post procedure depression (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitation\u003c/h2\u003e \u003cp\u003eThis study has many strengths, it tries to explore the lived experience of hysterectomized women in detail qualitatively. It used a direct interview which helps to dig out the real experience of participants. The study has two major limitations. First, this study was based on the experience of hysterectomized women that they want to tell their living status and there may be experiences that they did not want to tell. Second, this study focuses on the experience of hysterectomized women only; it did not take the experience of the close relatives like husband, children and any other close ones.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThirteen hysterectomized women had been interviewed during this study. This study explored the women's experiences after hysterectomy due to uterine rupture and uterovaginal prolapse in the Gedeo zone. Participants stated their lived experiences in a different way and finally thermalized into three thematic categories as limitations in daily activity, reproductive and sexual behaviour problems, and psychosocial burdens from society and from their close ones. Pain during movement, unable to lift heavy objects, infertility concerns, psychological, and social discomforts were stated as a predominant problem.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDUIRB\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDilla University Institutional Review Board\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKM\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ekilometre\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003eNGO\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNon-governmental Organization\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003ePAS\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePlacenta Accrete Spectrum\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003eSNNPR\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSouthern Nation Nationalities and Peoples Region\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003eUVP\u003c/b\u003e: Utro-vaginal Prolapse,\u003cb\u003eWHO\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWorld Health Organization.\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003ch2\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eEthical clearance was obtained from the research board of Dilla University (ethical code: duirb/32/22\u0026thinsp;\u0026minus;\u0026thinsp;01). Informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eCompeting of interest\u003c/h2\u003e \u003cp\u003eWe declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was funded by Dilla University.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEB, GA, TT, TB, and ZF developed the protocol. EB, GA, TT, TB, and ZF conducted the analyses, constructed summary of findings. EB, GA, TT, TB, and ZF drafted the manuscript. DGA drafted and critically reviewed the manuscript. All authors reviewed and edited the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our gratitude to everyone who have participated in conducting this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll relevant data collected from the study participants will be provided by the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThe WHO near. -miss approach for maternal health.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanovcinova L, Jandurova S. Subjective perceptions of life among women, 02009, 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElaine DY, Connor ZZ. Women \u0026rsquo; s experience of living with cervical cancer \u0026ndash; A descriptive review.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke-pearson DL. Complications Hysterect. 2013;121(3):654\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth-Related. Quality of Life After Hysterectomy _ Clinical Obstetrics and Gynecology.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuque S, Roberts I, Fawole B, Chaudhri R, Arulkumaran S. Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial. 2018;1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZirqi I, Al, Daltveit AK, Vangen S. Maternal outcome after complete uterine rupture. 2019;(February):1024\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams RD, Clark ANNJ. Hysterect Experience. 2000;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanda M et al. Patient-Reported Experiences After Hysterectomy: A Cross-Sectional Study of the Views of Over 2300 Women, 7, 3, pp. 372\u0026ndash;9, 2020, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2374373519840076\u003c/span\u003e\u003cspan address=\"10.1177/2374373519840076\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTenaw SG, Assefa N, Mulatu T, Tura AK. Maternal near miss among women admitted in major private hospitals in eastern Ethiopia: a retrospective study. 2021;1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReview S. SYSTEMATIC REVIEW WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. 2005;112(September):1221\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaddad SM, Cecatti JG, Souza JP, Sousa MH, Parpinelli MA, Costa ML et al. Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a. Multicenter Surveillance Study. 2014;2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eId AH, Wondimu M. Determinants of maternal near miss among women admitted to maternity wards of tertiary hospitals in Southern Ethiopia, 2020: A. 2021;1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke-pearson DL. Complications Hysterect. 2013;121(3):654\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhy might a. hysterectomy be done? 2018;(Fig. 1):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Culture and Tourism Authority. of Research and Conservation of Cultural Heritage, 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSouza P, Say L, Pattinson RC. Best Practice \u0026amp; Research Clinical Obstetrics and Gynaecology Maternal near miss \u0026ndash; towards a standard tool for monitoring quality of maternal health care q. 2009;23:287\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePattinson R, Say L, Souza P, Broek V, Den, Rooney C. Editorials WHO maternal death and near-miss classifications. 2009;9\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaye DK, Kakaire O, Nakimuli A, Osinde MO, Mbalinda SN, Kakande N. Lived experiences of women who developed uterine rupture following severe obstructed labor in Mulago hospital, Uganda. Reprod Health. 2014;11(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt A, Sehnem GD, Cardoso LS, Quadros JS, De, Ribeiro AC, Neves ET. Sexuality experiences of hysterectomized women. 2019;23(4):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStudy P. Experience of Palestinian Women After Hysterectomy Using a Descriptive Abstract: 2020;74\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanovcinova L, Jandurova S. Subjective perceptions of life among women. 2018;02009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePilli P, Sekweyama P, Kayira A. Women \u0026rsquo; s experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study. 2020;1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShirinkam F, Jannat-Alipoor Z, Shirinkam Chavari R, Ghaffari F. Sexuality After Hysterectomy: A Qualitative Study on Women\u0026rsquo;s Sexual Experience After Hysterectomy. Int J Womens Health Reprod Sci. 2017;6(1):27\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlshawish E, Qadous MS, Yamani MA. Experience of Palestinian Women After Hysterectomy Using a Descriptive Phenomenological Study. Open Nurs J. 2020;14(1):74\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarroll L, O\u0026rsquo; Sullivan C, Doody C, Perrotta C, Fullen B. Pelvic organ prolapse: The lived experience. Lagan\u0026agrave; AS. editor PLOS ONE. 2022;17(11):e0276788.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hysterectomy, Uterine rupture, Utero-vaginal prolapse, lived experience","lastPublishedDoi":"10.21203/rs.3.rs-5324393/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5324393/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eUterine rupture is a life-threatening obstetric emergency requiring immediate medical intervention to prevent maternal death or severe morbidity. Hysterectomy, often performed in response to uterine rupture and uterovaginal prolapse, is the most common gynecologic surgery in such cases. This study aimed to explore the lived experiences of women who underwent hysterectomy secondary to uterine rupture and uterovaginal prolapse.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eA phenomenological qualitative study was conducted among hysterectomized women at Dilla University Referral Hospital in 2020. Using purposive sampling, data were collected through structured in-depth interviews, supplemented by field notes, and audio recordings. A manual thematic analysis was employed to examine the data, and findings were presented in both text and table form.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThirteen women participated in the study, sharing their post-hysterectomy experiences due to uterine rupture and uterovaginal prolapse. Their narratives were categorized into three key themes: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) limitations in daily activities, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) reproductive and sexual health concerns, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) psychosocial burdens from societal and familial expectations. Common challenges included pain during movement, inability to lift heavy objects, anxiety about infertility, and significant psychological and social distress.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWomen who undergo hysterectomy due to uterine rupture and prolapse face significant physical, reproductive, and emotional challenges. Comprehensive post-surgical care and support are crucial. Addressing these needs can improve their quality of life.\u003c/p\u003e","manuscriptTitle":"Women’s Lived Experience with Hysterectomy secondary to uterine prolapse and uterine rupture at Gedeo zone, Ethiopia. A phenomenological qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-05 10:14:11","doi":"10.21203/rs.3.rs-5324393/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-28T18:41:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-25T03:18:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-25T03:17:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-10-24T09:03:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"44f372e4-5b06-453e-a016-a4415ba1c176","owner":[],"postedDate":"November 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T08:42:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-05 10:14:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5324393","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5324393","identity":"rs-5324393","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}