Assessment of prevalence, indications, outcomes and post operative complications of obstetric hysterectomy: at Mettu karel comprehensive specialized hospital, Mettu, south weast, Ethiopia

Assessment of prevalence, indications, outcomes and post operative complications of obstetric hysterectomy: at Mettu karel comprehensive specialized hospital, Mettu, south weast, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of prevalence, indications, outcomes and post operative complications of obstetric hysterectomy: at Mettu karel comprehensive specialized hospital, Mettu, south weast, Ethiopia Dagim Dagne This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7582759/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background: Obstetric hysterectomy is indicated when patient's life is at risk, related to significant maternal mortality and morbidity and it is also a potentially lifesaving procedure. In developed countries, the reported incidence of emergency hysterectomy is below 0.1% of the total normal deliveries performed, while in developing countries, the incidence rates are as high as 1-5/ 1000 of all the deliveries performed. Objective: The aim of the study was to estimate incidence, indications, risk factors and operative morbidity and mortality in pregnant women undergoing obstetric hysterectomy (OH) in seven years at Mettu Karle comprehensive specializedHospital: from April 2018 to April 2025 GC. Methods and Materials : A facility based retrospective cross sectional review of obstetric records was obtained over a period of seven years (April 2018 to April 2025 GC). Study was conducted from October 2018 to June 2025 GC. All women treated at Mettu Karle comprehensive specialized Hospital for the indication of obstetrics hysterectomy were included in the study. Data was collected with structured format. Results were analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0. For all statistical significance tests the cut off value set is P<0.05 and binary logistic regressions will use to estimate the crude odds ratios of maternal outcome. Result - There were a total of 8657 confinements and 65cases of OH was undertaken during the study period to give an incidence of 6.6/1000 deliveries with a maximum numbers of patients (n=20, 27.4 %) in the age group of >35yrs and parity of 3-4 (46.5%). Ruptured uterus (n=55, 75.3%), atonic PPH (n=6, 8.2%).), post partal sepsis and perforated uterus secondary to unsafe abortion (n=4, 5.5%) were the commonest causes for this life saving surgery. Out of the 65 hysterectomies performed, 56 (76.7%) were total hysterectomy and 17(23.3%) were subtotal hysterectomy. There were six maternal deaths (9.2%).Duration of hospital stay >4 hrs before operation (OR=7.5, CI=2.64-21.28) were statistically associated with maternal death. Conclusion and Recommendation : The incidence of OH and maternal death in Mettu Karle comprehensive specializedHospital was high. Good maternal care, ANC follow up, active management of labor, early recognition of complications and timely referral will go a long way in ensuring for a better outcome. Emergency Obstetric Hysterectomy Incidence Maternal death complication and associated risk factors Introduction Obstetric hysterectomy (OH) is the surgical removal of the pregnant or recently pregnant uterus. The term includes hysterectomy with the pregnancy in-situ, as well as operations related to complications of delivery (1, 2). Emergency hysterectomy during normal vaginal or cesarean deliveries is performed when all other measures to control life-threatening maternal hemorrhage have become futile (1–6). Although often referred to as "cesarean hysterectomy," the terms "peripartum" or "obstetric hysterectomy" are considered more accurate classifications (1). Obstetric hysterectomy, although rare in modern obstetrics, remains one of the world's most critical, life-saving surgical procedures (3, 7). Hemorrhage resulting from uterine rupture and atony, while rare in developed countries, continues to be a significant problem in developing nations (3, 6). The incidence of emergency hysterectomy in developed countries is below 0.1% of all deliveries, while in developing countries, rates can be as high as 1–5 per 1000 deliveries (6, 8). In the past, the most common indications for emergency peripartum hysterectomy were uterine atony and uterine rupture (3, 4, 9). However, more recent reports list placenta accreta as the most common indication, a trend that is most likely related to the increased number of cesarean deliveries observed over the past two decades (8, 10, 11). This is a major cause of obstetric hemorrhage and loss of reproductive organs (11). Despite its significant association with increased maternal morbidity and mortality, obstetric hysterectomy remains a crucial, potentially life-saving procedure (3, 4, 8, 13). It is a major surgical undertaking performed in the setting of life-threatening hemorrhage. Postpartum hemorrhage continues to be a leading cause of maternal mortality and morbidity worldwide (12, 14). The unplanned nature of this emergency surgery, coupled with the patient's often critical condition due to acute blood loss, makes it a complex and challenging procedure. In third-world countries like Ethiopia, major indications for OH include postpartum hemorrhage secondary to uterine atony, uterine rupture, and infected uteri. Other indications include complications from abortion, Gestational Trophoblastic Disease (GTD), and morbid placental adherence (3, 10, 15). The prevalence of OH is rising globally, largely due to the increase in cesarean section rates, which lead to morbidly adherent placentas (11, 17). This procedure requires not only excellent surgical skills but also prompt decision-making and a speedy intervention to be successful (6, 8, 12). The purpose of this study was to assess the prevalence, common indications, outcomes, and postoperative complications of obstetric hysterectomy at Mettu Karle comprehensive specialized Hospital in Mettu, Ethiopia. The research period spanned seven years, from April 2018 to April 2025. The study aimed to provide valuable data on the trends of OH in this specific hospital, helping to inform medical staff and managers about the most critical issues to address. The prevalence and outcomes of operative deliveries, particularly obstetric hysterectomy, are crucial in areas with a high rate of maternal morbidity and mortality due to limited access to Comprehensive Emergency Obstetric Care (CEmOC). This research holds significant importance as it is the first of its kind to be conducted at Mettu Karle Referral Hospital, a facility that plays a vital role in reducing maternal mortality and morbidity in the region. The findings will provide precise and reliable data on the rate of OH, its leading indications, and the associated pregnancy outcomes and postoperative complications. This information will be instrumental for the hospital staff, enabling them to understand the trends and common indications of OH and thereby improve clinical judgment and patient care. Hospital managers can use the study results to allocate resources more effectively to priority areas. Furthermore, the findings will assist other researchers, non-governmental organizations, and health departments at the zonal and regional levels in developing evidence-based strategies to improve maternal health outcomes. The best practices identified within the hospital may also serve as a model for other healthcare facilities facing similar challenges. Methods Study Design : This was a retrospective, cross-sectional study conducted at Mettu Karle comprehensive specialized Hospital. Study Area: Mettu Karle comprehensive specialized Hospital is located in Mettu Town, 595 km southwest of Addis Ababa. It serves an estimated 1.5 million people in the Illu-Ababora Zone and surrounding areas. The hospital has 291 staff members and 160 beds across various wards. The obstetric and gynecologic ward is equipped with two delivery coaches and several beds for different stages of labor and postpartum care. Source Population All pregnant women delivered and treated for obstetric indication at Mettu Karle Referral Hospital from April 2018 to April 2025 G.C. Study Population All women who were operated for the indication of obstetric hysterectomy at Mettu Karle comprehensive specialized Hospital from April 2018 to April 2025 G.C will include in the study. Sample size All women treated at Mettu Karle comprehensive specialized Hospital for the indication of obstetrics hysterectomy from April 2018 to April 2025 G.C was include in the study. Inclusion and Exclusion Criteria: Inclusion Criteria: All women for whom an emergency hysterectomy was performed for any indication during pregnancy, labor, or the puerperium within the specified study period. Exclusion Criteria: Women who had an elective hysterectomy, hysterectomies performed for gynecological indications, or cases where patient charts were lost or grossly incomplete. Women treated with elective schedule and hysterectomy performed for gynecologic indication was not included. Women whose charts was lost or grossly incomplete will not include in the study Data Processing and Analysis The collected data was entered, cleaned and analyzed using SPSS version 16.0. Socio- demographic and obstetric profile of patients undergone OH was summarized and presented by frequency tables, graphs and other summary statistic. Bivariate analysis was used to check association between dependent and independent variables. All variables that had significant association with p-value <0.25 in the bivariate analysis will be the candidate for multivariable logistic regression. Multivariable logistic regression model will be fitted to identify factors affecting the maternal out come. P-value less than 0.05 were considered as statistically significant. The degrees of association between dependent and independent variables will be assessed using OR at 95% CI. Data Quality Assurance To assure the quality of data, data collectors were trained before the actual study period. Regular supervision and follow up was made by principal investigator. In addition, regular check up for completeness and consistency of the data was making on daily basis. Possible correction or careful omission was doing during the actual study. Consultation from research advisor and potential resource persons will seek. Data sources was seven years (April 2018 to April 2025 GC) log-books review of the labor ward, maternity ward and major operations, Patient charts, discharge and death reports. A monthly and morning report was also review. First card number of women who had OH during the study period was identified from Operating Room (OR) logbooks, and then their charts have been retrieving from card office. Finally documents from patient cards will enter in to a structured format. Data Quality Management: To ensure data quality, all data collectors and supervisors underwent a two-day training session. A pre-test was conducted on 5% of the sample households, and the questionnaire was revised based on the results. After collection, each questionnaire was coded and the data was entered into Epi Data 3.1 before being exported to SPSS version 20 for analysis. To maintain accuracy, a 10% sample of the data entries was rechecked against the original questionnaires, and any errors were corrected. Data Analysis: The collected data was entered, cleaned, and analyzed using SPSS version 16.0 . Descriptive statistics, including frequency tables and graphs, were used to summarize the socio-demographic and obstetric profiles of the patients. Bivariate analysis was conducted to check for associations between dependent and independent variables, with variables having a p-value of less than 0.25 proceeding to multivariable logistic regression. A p-value of less than 0.05 was considered statistically significant for the final model. Data Quality Assurance: To ensure data quality, the data collectors were trained before the study . The principal investigator conducted regular supervision and follow-up. Daily checks for the completeness and consistency of the data were also performed, with any necessary corrections or omissions made during the study period. Operational Definitions: Obstetric hysterectomy - Hysterectomy performed for any indication during pregnancy, labor, and per peurium and abortion complication. Maternal death: is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Maternal outcome - Maternal condition after hysterectomy which can be good/favorable maternal outcome or poor/unfavorable maternal outcome Poor/unfavorable maternal outcome : includes mothers who developed post-operative complications after hysterectomy. Good/Favorable maternal outcome : mothers with smooth post-operative condition after hysterectomy. Perinatal mortality rate: is most often defined as fetal death that occurs between the periods from the 28 th wk of gestation through the 7 th day after birth. Associated obstetric problems – Maternal conditions like previous CS, PPH/APH, sepsis (pelvic infection) and others like trauma and previous fistula repair that are identified before the procedure. Maternal complication – maternal morbidity (condition) during operation or after operation of OH Uterine rupture: defined as loss of continuity of the wall of the uterus, after cessation of contraction. PPH: Excessive bleeding following delivery (>500 ml in vaginal delivery, >1000 ml in CD and twin vaginal deliveries, >1500 ml following cesarean hysterectomy) or a drop in Hct> 10% from baseline or derangement in vital sign following bleeding after delivery. Definition of key terms Gestational Age –The duration of pregnancy in weeks which is calculated based on Last Normal Menstrual Period (LNMP) and/or duration of amenorrhea claimed by the mother and/or by Physical Examination (PE). Mode of delivery –obstetric procedure to attend delivery of the baby like vaginal delivery, CS, laparatomy and destructive delivery. Sepsis (pelvic infection)- clinically diagnosed chorioamnionities, endometrities and pelvic peritonitis. Ethical Consideration Ethical clearance was obtained from the Mattu University Institutional Review Board (IRB), Faculty of Public Health and Medical Sciences. The study was conducted in accordance with the principles of the Declaration of Helsinki. Since this was a retrospective review of medical records, informed consent from patients was waived by the IRB. Confidentiality of patient information was strictly maintained, and data were used solely for research purposes. Ethics Approval and Consent to Participate Ethical clearance was obtained from the Mattu University Institutional Review Board (IRB), Faculty of Public Health and Medical Sciences. The study was conducted in accordance with the Declaration of Helsinki. Since this was a retrospective review of medical records, informed consent from patients was waived by the IRB. Confidentiality of patient information was strictly maintained, and data were used solely for research purposes. Results During the seven-year study period (April 2018–April 2025 E.C.), a total of 9,875 deliveries were conducted at Mettu Karle comprehensive specialized Hospital. Of these, 9,153 (92.7%) were vaginal deliveries, 657 (6.7%) were cesarean sections, and 65 cases (0.66%) were obstetric hysterectomies (OH) performed for obstetric indications. The retrieval rate of case records was 97%. Hysterectomies included those performed during pregnancy, labor, or puerperium, as well as for complications following pregnancy termination such as perforation and sepsis. All were performed on an emergency basis. (Table 1). Socio-demographic Characteristics The age of patients ranged from 22 to 41 years, with a mean of 30.09 years. The majority (40%) were between 25–29 years, followed by 24.6% in the 30–34 year group, 18.5% in the 35–39 year group, and 7.7% in the 40–44 year group. Only 9.2% were between 20–24 years. More than half of the patients (55.4%) lived within 100 km of the hospital, including those from Mettu town. (Table 2). Obstetric Profile of Patients Parity ranged from 2–8 with a mean of 5.18. Nearly half of the patients (46.6%) were para 3–4, while 27.4% were para 5 or above. The majority of cases (63.1%) had no antenatal care (ANC) follow-up, while 36.9% did. At admission, 81.5% of patients were between 37–42 weeks of gestation, 16.9% had unknown gestational age, and 1.5% were beyond 42 weeks. (Table 3). Most patients (75.4%) stayed in the hospital less than 4 hours before surgery. In terms of delivery mode, 83.1% underwent laparotomy for ruptured uterus, 15.2% delivered vaginally, and one patient had destructive delivery. Sepsis of pelvic origin (10.6%) was the most common associated obstetric problem, followed by antepartum/postpartum hemorrhage (7.6%), previous cesarean scar (6.1%), pregnancy-induced hypertension (4.5%), morbidly adherent placenta (4.5%), and antepartum hemorrhage (3.5%). A majority (64.4%) labored for more than 48 hours before hysterectomy. Incidence and Indications of OH The overall frequency of OH was 0.66% (6.6 per 1000 deliveries). The leading indication was ruptured uterus (81.5%), followed by morbidly adherent placenta (6.2%), postpartum hemorrhage due to uterine atony (4.6%), postpartum uterine sepsis (4.6%), and uterine perforation from unsafe abortion (3.1%). Total abdominal hysterectomy (78.2%) was more common than subtotal hysterectomy (21.6%). The average procedure lasted 2.03 hours (range: 1–4 hours). (Table 4). Intra- and Post-operative Complications Intraoperatively, hypovolemic shock occurred in 60% of patients, septic shock in 16.9%, bladder injuries in 15.4% (all repaired), and fistula in 1.5%. Postoperatively, anemia was the most common complication (90.8%), followed by wound infection/dehiscence (27.7%) and sepsis (26.2%). Maternal Outcomes There were six maternal deaths (9.2%). Two resulted from multi-organ failure due to septic shock, two from anesthesia complications, and two from cardiorespiratory failure secondary to hypovolemic shock. The majority of patients (70.8%) were discharged within 8–15 days, 20% within 22 days, and 9.2% within 7 days. Prolonged hospital stay was mainly due to sepsis and wound infection. Factors Associated with Maternal Outcomes Several factors were significantly associated with maternal outcome: (Table 5). Age: Women aged 35–39 years had significantly worse outcomes compared to those under 30 years. Referral status: Non-referred patients had higher unfavorable outcomes (80%) compared to referred patients (20%). ANC follow-up: Absence of ANC follow-up was strongly associated with unfavorable outcomes (86.8% vs. 13.2%). Hospital stay before operation: Patients who stayed ≥4 hours before surgery had worse outcomes compared to those operated within 4 hours. Duration of surgery: Operations lasting >1 hour were associated with unfavorable outcomes (84.8% vs. 15.2%). Intraoperative complications: Both hypovolemic and septic shock were strongly linked to poor outcomes. Blood loss and transfusion: Patients with severe blood loss and those not transfused had significantly worse outcomes. Duration of labor: Labor >24 hours was associated with unfavorable outcomes (68.2%). Multivariate Logistic Regression Final analysis identified three independent predictors of unfavorable maternal outcome: (Table 7). Lack of ANC follow-up – patients were 7.5 times more likely to have unfavorable outcomes compared to those with ANC visits. Hypovolemic shock during surgery – patients were 16 times more likely to have unfavorable outcomes compared to those without shock. Duration of surgery >1 hour – patients were 9.5 times more likely to have unfavorable outcomes compared to those operated within 1 hour. Discussion Obstetric hysterectomy (OH) is a radical, life-saving surgical procedure, most often carried out for life-threatening indications. The most critical surgeon-related factors influencing maternal outcomes are rapid decision-making and timely execution of the surgery [7]. This study was conducted to analyze maternal mortality, morbidity, and associated factors among women who underwent OH at Mettu Karle compressive specialized Hospital. Socio-demographic Characteristics The age of patients ranged from 22–41 years, with a mean of 30.09 years (SD = 0.61), which is consistent with the study by Lamba & Gupta (mean age = 30.05 years) [16]. The highest frequency was in the 25–29 year age group (40%), followed by 30–34 years (24.6%) and 35–39 years (18.5%). Only 7.7% of patients were between 20–24 years. This trend is similar to results from Kashani & Azarhoush (2012) [6] and Anita & Kavita (2005), who reported the youngest patient as 22 years and the oldest as 39 years [8]. (Table 2). Parity Parity ranged from 2–8 with a mean of 5.18, nearly identical to Ethiopia’s rural fertility rate of 5.5 (EDHS, 2011). Most women were multiparous, with 46.6% para 3–4 and 27.4% para ≥5. This indicates that OH was most frequent among multiparous women, a finding consistent with Alsayali & Baloul (2000) and Kashani & Azarhoush (2012) [1,4]. The higher incidence among multiparous women is a risk factor widely documented in other studies [8]. (Table 3). (EDHS, 2011) [18]. Similar risk factors were also reported in Taiwan [19]. Antenatal Care Effective antenatal care, identification of high-risk patients, adequate transfusion facilities, and improved surgical skills are essential to reducing OH-related morbidity [1]. In this study, 63.1% of patients had no ANC follow-up. Among them, 81.5% experienced unfavorable maternal outcomes. This is comparable with Anita & Kavita (2005), who reported 73.1% unfavorable outcomes in women without ANC [8]. Surgical Duration and Experience There was a strong association between duration of surgery (>1 hour) and unfavorable outcomes (OR = 9.5, 95% CI 1.3–67.2). Delays were attributed to poor patient condition, shortage of obstetricians, and cases handled by trainee general practitioners. Prolonged anesthesia exposure also contributed. OH performed by experienced surgeons significantly reduces operating time, transfusion requirements, and hospital stay [14]. When conservative treatment fails, OH should not be delayed, as postponement increases blood loss, transfusion needs, operative time, disseminated intravascular coagulation, and ICU admissions [14]. In this study, 41.5% of patients required blood transfusion, though shortages and family refusal to donate blood were major challenges. Comparatively, other studies reported transfusion in 92% of OH cases, with 20% developing coagulopathy [22] Intraoperative Hypovolemic Shock Hypovolemic shock was strongly associated with maternal outcomes (OR = 16.1, 95% CI 2.1–120.6). Lack of blood bank services and refusal of family donors were significant contributing factors. Incidence of OH In developed countries, emergency hysterectomy incidence is below 0.1% of deliveries, while in developing countries it ranges between 1–5 per 1000 [3,6]. The incidence in this study was 6.6 per 1000 deliveries, which is high but comparable to figures reported elsewhere. Ambiye & Venkatraman reported an incidence of 67.8% [9], and global reports range from 0.24–8.9 per 1000 deliveries [14]. The higher rate here is explained by very low institutional delivery coverage (6.9%) compared to 50% in urban facilities (EDHS, 2011), and the high proportion of referred cases—95.4% of patients in this study. Indications for OH The leading indication was uterine rupture (81.5%), higher than the 75% reported by Archana et al. [7]. Causes included previous cesarean scar (4 cases), trauma (1 case), and prolonged labor (64.4%). Most women presented late, often after complications had already occurred, which aligns with Lamba & Gupta (2012) [16]. Prior cesarean section increases OH risk due to placenta previa/accreta and uterine rupture [2]. Morbidly adherent placenta (6.2%) was the second most common indication. Similar findings were reported in other studies [2,4,5], though at higher rates (16–28%). The lower incidence in this study is likely due to the predominance of uterine rupture. Other less frequent indications included postpartum hemorrhage from uterine atony (4.6%), postpartum sepsis (4.6%), and uterine perforation from destructive delivery (3.1%). These figures are comparable to Kashani & Azarhoush (2012) [4] and Anita & Kavita [8]. Maternal Mortality There were six maternal deaths (9.2%), consistent with Ambiye & Venkatraman’s findings (9.3%). Causes included irreversible hemorrhagic shock due to ruptured uterus (2 cases), cardiorespiratory failure related to anesthesia (2 cases), and multi-organ failure secondary to septic shock (2 cases). The rest were discharged: 70.8% within 8–15 days, 20% within 16–22 days, and 9.2% within 7 days. Prolonged stays were primarily due to sepsis and wound infections. Similar causes of death and complications were reported by Lamba & Gupta (2012) [16]. Proper timing of OH and meticulous perioperative care may reduce complications such as coagulopathy, severe hypovolemia, tissue hypoxia, hypothermia, and acidosis. Type of Surgery Total hysterectomy was the most frequently performed procedure (76.7%). While subtotal hysterectomy is often preferred in unstable patients due to being faster and less hemorrhagic, total hysterectomy is recommended because of risks associated with leaving the cervical stump, including malignancy and persistent bleeding [6,8,16]. In this study, the choice was likely based on surgeon experience and patient condition. Intraoperative and Postoperative Complications Hypovolemic shock (24.6%) was the most common intra operative complication, followed by septic shock (10.9%). Both were significantly associated with poor outcomes (OR = 16.1, 95% CI 2.1–120.6). Bladder injuries occurred in 15.4% of cases, and one fistula (1.5%) was reported; all bladder injuries were repaired. These findings are consistent with Tallab Fassil (16%) [7]. Comparable findings were also reported in previous studies [21]. Postoperative complications included anemia (90.8%), sepsis (26.2%), and wound infection or dehiscence (27.7%). These rates are consistent with findings by Lamba & Gupta (2012) and Tallab Fassil [7,16]. Other studies (Naureen Javed and Sumera Tahir) also report sepsis and wound infection as leading postoperative complications, often linked to massive hemorrhage and hypovolemic shock [6,12] Strength of the Study As to my knowledge this research is the first research performed in the hospital to this area of interest Limitations Time constraints Very low institutional delivery rate at the Hospital Conclusion The incidence of obstetric hysterectomy (OH) at Mettu Karle compressive specialized Hospital was found to be high, with uterine rupture being the leading indication. All cases of uterine perforation secondary to destructive delivery required OH, and the most common procedure performed was total abdominal hysterectomy. The major complications encountered were hypovolemic shock and postoperative sepsis. Longer preoperative hospital stay (>4 hours) [COR=7.5, 95% CI: 2.64–21.28, p=0.000] and septic shock [COR=16.1, 95% CI: 2.1–120.6, p=0.007] were significantly associated with maternal death. There were six maternal deaths: four due to multi-organ failure from hypovolemic and septic shock, and two related to anesthesia complications. Overall, OH remains a life-saving intervention, but favorable outcomes depend on promptdecision-making, skilled surgical care, effective maternal health services, active labor management, early recognition of complications, and timely referral.. Recommendations The study recommends improving proper chart keeping and documentation, ensuring early recognition and management of complications, and strengthening antenatal care with timely referral of high-risk cases. Emergency obstetric care should be expanded, with Basic EmOC available at health centers and Comprehensive EmOC, including caesarean sections and blood transfusions, at district hospitals. Additionally, upgrading peripheral health services, improving transportation, providing refresher training, and deploying skilled professionals in rural areas are essential. Abbreviations ANC Antenatal Care APH Ante Partum Hemorrhage BEmOC Basic Emergency Obstetric Care BSC Bachelor of science CEmOC Comprehensive Emergency Obstetric Care CD Caesarean Delivery DIC Disseminated Intravascular Coagulopathies EmOC Emergency Obstetric Care EDHS Ethiopian Demographic and Health Survey OH Obstetric Hysterectomy GA Gestational Age GTD Gestational Trophoblastic Disease HIV Human Immune Deficiency Virus ICU Intensive Care Unit IEOS Integrated Emergency Obstetrics and Gynecology and General Surgery LUSCD Lower uterine Segment Caesarian Delivery MMR Maternal Mortality Ratio MRI Magnetic Resonant Imaging MD Medical doctor NGO Non Governmental Organization OR Operating room PGE2 Prostaglandin group E2 PPH Post Partum Hemorrhage Declarations Consent for Publication: Not applicable. Availability of Data and Materials: Data are available upon reasonable request from the corresponding author. Competing Interests: The authors declare no competing interests. Funding: This study was self-funded. Author Contributions Dagim Dagne is the sole author. The author read and approved the final manuscript. Acknowledgments The author thanks Mattu University, Mettu Karle compressive specialized hospital and data collectors for their support. Special gratitude to study participants for their invaluable contributions. References Alsayali ARA, Baloul SMA. EMERGENCY OBSTETRIC HYSTERECTOMY: 8-YEAR REVIEW AT TAIF MATERNITY HOSPITAL, SAUDI ARABIA. Ann. Saudi Med. 2000;20(June):454–6. Korejo R, Nasir A, Yasmin H, Bhutta S. Original Article Emergency Obstetric Hysterectomy. J Pak Med Assoc. 2012;64(12):1322–5. Baskett TF. Peripartum Hysterectomy. 2010;462–5. Kashani E, Azarhoush R. Peripartum hysterectomy for primary postpartum hemorrhage: 10 years evaluation. 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Kwakye AK, Seffah JD, PERIPARTUM HYSTERECTOMIES AT THE KORLE-BU, TEACH-. ING HOSPITAL: A REVIEW OF 182 CONSECUTIVE CASES. Ghana Med. J. 2007;41(3):133–8. Machado LSM. Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome. N Am J Med Sci. 2011;3(8):6–9. Lee RH, et al. Emergency Postpartum Hysterectomy for A Systematic Review. Obs Gynecol. 2010;115(3):637–44. Lamba J, Gupta S. Role of Emergency Hysterectomy in Modern Obstetrics. JK Sci. 2012;14(1):22–4. Naqvi KZ, Thontia S. Peripartum Hysterectomy. J Surg Pakistan. 2013;18(June):97–100. Ethiopia. Demographic and Health Survey Preliminary Report. 2011. Yang M, Wang P. Peripartum Hysterectomy Risk Factors in Taiwan. J Chin Med Assoc. 2010;73(8):399–400. Nnadi EN. and D. Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto, Nigeria. Ann Med Heal Sci Res; 2((1)):: 37–40. PERVEEN F, et al. Original Article PERIPARTUM HYSTERECTOMY FOR PRIMARY. Q Med Channel. 2012;19(3):34–7. Masheer S, Najmi N. Peripartum Hysterectomy Versus Non Obstetrical Hysterectomy.Hosp. J Chin Med Assoc. 2010;;73((7))::360–363. Tables Table 1 : Data of obstetric interventions at Mettu Karle compressive specialized Hospital from April 2018-April 2025 GC Mode of delivery Number (N) Percentage (%) Vaginal delivery 9153 92.7 Laparatomy + CD 657 6.7 Obstetric hysterectomy 65 0.6 Total number of delivery 9875 100 Table 1: Distribution of obstetric interventions at Mettu Karle Comprehensive Specialized Hospital, April 2018–April 2025. Table 2: Age wise distribution of patients who undergone OH at Mettu Karle compressive specialized Hospital for the indication of obstetrics hysterectomy from April 2018- April 2025 G.C Age Number of pts Frequency Cumulative % 15-19 0 0 0 20-24 6 9.2 9.2 25-29 26 40.0 49.2 30-34 16 24.6 73.8 35-39 12 18.5 92.3 40-44 5 7.7 100.0 ≥45 0 0 100.0 Total 65 100 100.0 Table 2: Age-wise distribution of patients who underwent obstetric hysterectomy at Mettu Karle Comprehensive Specialized Hospital, April 2018–April 2025. Table 3: Obstetric profile of the patients undergone obstetric hysterectomy at Mettu Karle compressive specialized Hospital from April 2018- April 2025(n=65). Variables Number(N) Percentage (%) Gestational age in weeks 37-42 53 81.5 >42 1 1.5 Unknown 11 16.9 Parity 1 0 0 2 1 1.5 3 5 7.6 4 13 19.7 >=5 46 69.7 Mother came with referral Yes 45 69.7 No 20 30.3 Distance ˂100kms 40 61.5 ≥100kms 25 38.5 Duration of hospital stay before operation in hrs ≤4hrs 49 75.4 >4hrs 16 24.6 Mode of delivery Laparatomy 10 15.4 Vaginal delivery 54 83.1 Others * 1 1.5 ANC follow up visit Yes 24 36.9 No 41 63.1 Table 3: Obstetric profile of patients who underwent obstetric hysterectomy at Mettu Karle Comprehensive Specialized Hospital, April 2018–April 2025. Table 4: Indication for OH at Mettu Karle compressive specialized Hospital from April 2018- April 2025 Complication Number(n) % Intra operative Septic shock 11 16.9 Hypo volumic shock 39 24.6 No complication 15 64.3 Postoperative Sepsis 10 15.4 Wound infection and or dehiscence 6 9.2 Anemia 59 90.4 No complications 7 10.8 Table 4: Indications for obstetric hysterectomy at Mettu Karle Comprehensive Specialized Hospital, April 2018–April 2025. Table 5: Bivariate logistic regression of socio demographic factors with maternal outcome of OH (N=65) at Mettu Karle compressive specialized Hospital from April 2018- April 2025 S no variables Maternal outcome P value COR(95% CI) Favorable Unfavorable N (%) N (%) 1 Age 20-24 5(83.3) 1(16.7) 1 25-29 7(58.3) 5(41.7) 1 30-34 6(37.5) 10(62.5) 1 35-39 8(30.8) 18(69.2) .039 11.3(1.1-112.5) ≥40 1(20) 480() 1 2 Comes with referral Yes 23(51.1) 22 (48.9) No 4 (20) 16(80) . 024 4.2 (1.2- 14.5) 3 ANC follow up Yes 19(70.4) 8(29.6) No 5(13.2) 33(86.8) .000 15.7(4.5-54.8) Table 5: Bivariate logistic regression of socio-demographic factors with maternal outcomes among women undergoing obstetric hysterectomy (N=65), April 2018–April 2025. Table 6: Bivariate logistic regression analysis of socio-demographic factors risk factors for maternal outcome in underwent OH (N=65) at Mettu Karle compressive specialized Hospital from April 2018- April 2025 S no v ariables Maternal outcome P value COR(95% CI) Favorable Unfavorable N (%) N (%) 1 Age 20-24 5(83.3) 1(16.7) 1 25-29 7(58.3) 5(41.7) 1 30-34 6(37.5) 10(62.5) 1 35-39 8(30.8) 18(69.2) .039 11.3(1.1-112.5) ≥40 1(20) 480() 1 2 Comes with referral Yes 23(51.1) 22 (48.9) No 4 (20) 16(80) . 024 4.2 (1.2- 14.5) 3 ANC follow up Yes 19(70.4) 8(29.6) No 5(13.2) 33(86.8) .000 15.7(4.5-54.8) 15.675 Table 6: Bivariate logistic regression analysis of socio-demographic risk factors associated with maternal outcomes in obstetric hysterectomy cases (N=65), April 2018–April 2025. Table 7: Multivariate logistic regression analysis of risk factors for maternal outcome who underwent OH (N=65) at Mettu Karle compressive specialized Hospital from April 2018- April 2025 SN o Variables Maternal outcome COR (95% of CI) AOR (95% CI) P Value favorable N (%) unfavorable N (%) 1 ANC FOLLOW UP No 1(50) 1(50) 15.7(4.5-54.8) 9.4 (1.2-70.95) .030 Yes 24(77.4) 7(22.6) 1 2 Hypo-volumic shock Yes 21(80.8) 5(19.2) 9.100(2.8,29.9) 16.1 (2.2-119.8) .007 No 12(31.6) 26(68.4) 1 3 Duration of procedure <1hr 22(68.8) 10(31.2) 1 1 ≥1hr 5(15.2) 28(84.8) 11.44 (3.4,38.5) 9.5 (1.3-67.2) .024 Table 7: Multivariate logistic regression analysis of risk factors for maternal outcomes among women who underwent obstetric hysterectomy (N=65), April 2018–April 2025. Additional Declarations No competing interests reported. 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The term includes hysterectomy with the pregnancy in-situ, as well as operations related to complications of delivery (1, 2). Emergency hysterectomy during normal vaginal or cesarean deliveries is performed when all other measures to control life-threatening maternal hemorrhage have become futile (1\u0026ndash;6). Although often referred to as \"cesarean hysterectomy,\" the terms \"peripartum\" or \"obstetric hysterectomy\" are considered more accurate classifications (1).\u003c/p\u003e\u003cp\u003eObstetric hysterectomy, although rare in modern obstetrics, remains one of the world's most critical, life-saving surgical procedures (3, 7). Hemorrhage resulting from uterine rupture and atony, while rare in developed countries, continues to be a significant problem in developing nations (3, 6). The incidence of emergency hysterectomy in developed countries is below 0.1% of all deliveries, while in developing countries, rates can be as high as 1\u0026ndash;5 per 1000 deliveries (6, 8). In the past, the most common indications for emergency peripartum hysterectomy were uterine atony and uterine rupture (3, 4, 9). However, more recent reports list placenta accreta as the most common indication, a trend that is most likely related to the increased number of cesarean deliveries observed over the past two decades (8, 10, 11). This is a major cause of obstetric hemorrhage and loss of reproductive organs (11).\u003c/p\u003e\u003cp\u003eDespite its significant association with increased maternal morbidity and mortality, obstetric hysterectomy remains a crucial, potentially life-saving procedure (3, 4, 8, 13). It is a major surgical undertaking performed in the setting of life-threatening hemorrhage. Postpartum hemorrhage continues to be a leading cause of maternal mortality and morbidity worldwide (12, 14). The unplanned nature of this emergency surgery, coupled with the patient's often critical condition due to acute blood loss, makes it a complex and challenging procedure. In third-world countries like Ethiopia, major indications for OH include postpartum hemorrhage secondary to uterine atony, uterine rupture, and infected uteri. Other indications include complications from abortion, Gestational Trophoblastic Disease (GTD), and morbid placental adherence (3, 10, 15). The prevalence of OH is rising globally, largely due to the increase in cesarean section rates, which lead to morbidly adherent placentas (11, 17). This procedure requires not only excellent surgical skills but also prompt decision-making and a speedy intervention to be successful (6, 8, 12).\u003c/p\u003e\u003cp\u003eThe purpose of this study was to assess the prevalence, common indications, outcomes, and postoperative complications of obstetric hysterectomy at Mettu Karle comprehensive specialized Hospital in Mettu, Ethiopia. The research period spanned seven years, from April 2018 to April 2025. The study aimed to provide valuable data on the trends of OH in this specific hospital, helping to inform medical staff and managers about the most critical issues to address. The prevalence and outcomes of operative deliveries, particularly obstetric hysterectomy, are crucial in areas with a high rate of maternal morbidity and mortality due to limited access to Comprehensive Emergency Obstetric Care (CEmOC).\u003c/p\u003e\u003cp\u003eThis research holds significant importance as it is the first of its kind to be conducted at Mettu Karle Referral Hospital, a facility that plays a vital role in reducing maternal mortality and morbidity in the region. The findings will provide precise and reliable data on the rate of OH, its leading indications, and the associated pregnancy outcomes and postoperative complications. This information will be instrumental for the hospital staff, enabling them to understand the trends and common indications of OH and thereby improve clinical judgment and patient care. Hospital managers can use the study results to allocate resources more effectively to priority areas. Furthermore, the findings will assist other researchers, non-governmental organizations, and health departments at the zonal and regional levels in developing evidence-based strategies to improve maternal health outcomes. The best practices identified within the hospital may also serve as a model for other healthcare facilities facing similar challenges.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e This was a retrospective, cross-sectional study conducted at Mettu Karle comprehensive specialized Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Area:\u003c/strong\u003e \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMettu Karle comprehensive specialized Hospital is located in Mettu Town, 595 km southwest of Addis Ababa. It serves an estimated 1.5 million people in the Illu-Ababora Zone and surrounding areas. The hospital has 291 staff members and 160 beds across various wards. The obstetric and gynecologic ward is equipped with two delivery coaches and several beds for different stages of labor and postpartum care.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSource Population\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll pregnant women delivered and treated for obstetric indication at Mettu Karle Referral Hospital from April 2018 to April 2025 G.C.\u003c/p\u003e\n\u003ch2 id=\"_Toc482412334\"\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll women who were operated for the indication of obstetric hysterectomy at Mettu Karle\u0026nbsp;comprehensive specialized Hospital from April 2018 to April 2025 G.C will include in the study.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc482412335\"\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll women treated at Mettu Karle\u0026nbsp;comprehensive specialized Hospital for the indication of obstetrics hysterectomy from April 2018 to April 2025 G.C was include in the study.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eInclusion and Exclusion Criteria:\u003c/strong\u003e\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e All women for whom an \u003cstrong\u003eemergency hysterectomy\u003c/strong\u003e was performed for any indication during pregnancy, labor, or the puerperium within the specified study period.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e Women who had an elective hysterectomy, hysterectomies performed for gynecological indications, or cases where patient charts were lost or grossly incomplete. Women treated with elective schedule and hysterectomy performed for gynecologic indication was not included. Women whose charts was lost or grossly incomplete will not include in the study\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003e\u003cstrong\u003eData Processing and Analysis\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;The collected data was entered, cleaned and analyzed using SPSS version 16.0. Socio- demographic and obstetric profile of patients undergone OH was summarized and presented by frequency tables, graphs and other summary statistic. Bivariate analysis was used to check association between dependent and independent variables. All variables that had significant association with p-value \u0026lt;0.25 in the bivariate analysis will be the candidate for multivariable logistic regression. Multivariable logistic regression model will be fitted to identify factors affecting the maternal out come. P-value less than 0.05 were considered as statistically significant. The degrees of association between dependent and independent variables will be assessed using OR at 95% CI.\u003c/p\u003e\n\u003ch2 id=\"_Toc393466760\"\u003e\u003cstrong\u003eData Quality Assurance\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; To assure the quality of data, data collectors were trained before the actual study period. Regular supervision and follow up was made by principal investigator. In addition, regular check up for completeness and consistency of the data was making on daily basis. Possible correction or careful omission was doing during the actual study. Consultation from research advisor and potential resource persons will seek.\u003c/p\u003e\n\u003cp id=\"_Toc286055801\"\u003e\u0026nbsp;Data sources was seven years (April 2018 to April 2025 GC) log-books review of the labor ward, maternity ward and major operations, Patient charts, discharge and death reports. A monthly and morning report was also review. \u0026nbsp;First card number of women who had OH during the study period was identified from Operating Room (OR) logbooks, and then their charts have been retrieving from card office. Finally documents from patient cards will enter in to a structured format.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Quality Management:\u003c/strong\u003e To ensure data quality, all data collectors and supervisors underwent a two-day training session. A pre-test was conducted on 5% of the sample households, and the questionnaire was revised based on the results. After collection, each questionnaire was coded and the data was entered into Epi Data 3.1 before being exported to SPSS version 20 for analysis. To maintain accuracy, a 10% sample of the data entries was rechecked against the original questionnaires, and any errors were corrected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis:\u003c/strong\u003e The collected data was entered, cleaned, and analyzed using \u003cstrong\u003eSPSS version 16.0\u003c/strong\u003e. Descriptive statistics, including frequency tables and graphs, were used to summarize the socio-demographic and obstetric profiles of the patients. Bivariate analysis was conducted to check for associations between dependent and independent variables, with variables having a p-value of less than 0.25 proceeding to multivariable logistic regression. A p-value of less than 0.05 was considered statistically significant for the final model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Quality Assurance:\u003c/strong\u003e To ensure data quality, the data collectors were \u003cstrong\u003etrained before the study\u003c/strong\u003e. The principal investigator conducted regular supervision and follow-up. Daily checks for the completeness and consistency of the data were also performed, with any necessary corrections or omissions made during the study period.\u003c/p\u003e\n\u003ch1\u003e\u003cstrong\u003eOperational Definitions:\u003c/strong\u003e\u003c/h1\u003e\n\u003cp\u003e\u003cstrong\u003eObstetric hysterectomy -\u003c/strong\u003e Hysterectomy performed for any indication during pregnancy, labor, and per peurium and abortion complication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal death:\u003c/strong\u003e is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal outcome -\u003c/strong\u003eMaternal condition after hysterectomy which can be good/favorable maternal outcome or poor/unfavorable maternal outcome\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePoor/unfavorable maternal outcome\u003c/strong\u003e: includes mothers who developed post-operative complications after hysterectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGood/Favorable maternal outcome\u003c/strong\u003e: mothers with smooth post-operative condition after hysterectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerinatal mortality rate:\u003c/strong\u003e\u0026nbsp; is most often defined as fetal death that occurs between the periods from the 28\u003csup\u003eth\u003c/sup\u003ewk of gestation through the 7\u003csup\u003eth\u003c/sup\u003e day after birth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociated obstetric problems\u0026nbsp;\u003c/strong\u003e\u0026ndash; Maternal conditions like previous CS, PPH/APH, sepsis (pelvic infection) and others like trauma and previous fistula repair that are identified before the procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal complication \u0026ndash;\u003c/strong\u003ematernal morbidity (condition) during operation or after operation of OH\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUterine rupture:\u003c/strong\u003e defined as loss of continuity of the wall of the uterus, after cessation of contraction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePPH:\u0026nbsp;\u003c/strong\u003eExcessive bleeding following delivery (\u0026gt;500 ml in vaginal delivery, \u0026gt;1000 ml in CD and twin vaginal deliveries, \u0026gt;1500 ml following cesarean hysterectomy) or a drop in Hct\u0026gt; 10% from baseline or derangement in vital sign following bleeding after delivery.\u003c/p\u003e\n\u003cp id=\"_Toc482412343\"\u003e\u0026nbsp;\u003cstrong\u003eDefinition of key terms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGestational Age\u0026nbsp;\u003c/strong\u003e\u0026ndash;The duration of pregnancy in weeks which is calculated based on Last Normal Menstrual Period (LNMP) and/or duration of amenorrhea claimed by the mother and/or by Physical Examination (PE).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMode of delivery\u0026nbsp;\u003c/strong\u003e\u0026ndash;obstetric procedure to attend delivery of the baby like vaginal delivery, CS, laparatomy and destructive delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSepsis (pelvic infection)-\u003c/strong\u003eclinically diagnosed chorioamnionities, endometrities and pelvic peritonitis.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eEthical clearance was obtained from the Mattu University Institutional Review Board (IRB), Faculty of Public Health and Medical Sciences. The study was conducted in accordance with the principles of the Declaration of Helsinki. Since this was a retrospective review of medical records, informed consent from patients was waived by the IRB. Confidentiality of patient information was strictly maintained, and data were used solely for research purposes.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eEthical clearance was obtained from the Mattu University Institutional Review Board (IRB), Faculty of Public Health and Medical Sciences. The study was conducted in accordance with the Declaration of Helsinki. Since this was a retrospective review of medical records, informed consent from patients was waived by the IRB. Confidentiality of patient information was strictly maintained, and data were used solely for research purposes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the seven-year study period (April 2018\u0026ndash;April 2025 E.C.), a total of 9,875 deliveries were conducted at Mettu Karle comprehensive specialized Hospital. Of these, 9,153 (92.7%) were vaginal deliveries, 657 (6.7%) were cesarean sections, and 65 cases (0.66%) were obstetric hysterectomies (OH) performed for obstetric indications. The retrieval rate of case records was 97%. Hysterectomies included those performed during pregnancy, labor, or puerperium, as well as for complications following pregnancy termination such as perforation and sepsis. All were performed on an emergency basis. (Table 1).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eSocio-demographic Characteristics\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe age of patients ranged from 22 to 41 years, with a mean of 30.09 years. The majority (40%) were between 25\u0026ndash;29 years, followed by 24.6% in the 30\u0026ndash;34 year group, 18.5% in the 35\u0026ndash;39 year group, and 7.7% in the 40\u0026ndash;44 year group. Only 9.2% were between 20\u0026ndash;24 years. More than half of the patients (55.4%) lived within 100 km of the hospital, including those from Mettu town. (Table 2).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eObstetric Profile of Patients\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eParity ranged from 2\u0026ndash;8 with a mean of 5.18. Nearly half of the patients (46.6%) were para 3\u0026ndash;4, while 27.4% were para 5 or above. The majority of cases (63.1%) had no antenatal care (ANC) follow-up, while 36.9% did. At admission, 81.5% of patients were between 37\u0026ndash;42 weeks of gestation, 16.9% had unknown gestational age, and 1.5% were beyond 42 weeks. (Table 3).\u003c/p\u003e\n\u003cp\u003eMost patients (75.4%) stayed in the hospital less than 4 hours before surgery. In terms of delivery mode, 83.1% underwent laparotomy for ruptured uterus, 15.2% delivered vaginally, and one patient had destructive delivery. Sepsis of pelvic origin (10.6%) was the most common associated obstetric problem, followed by antepartum/postpartum hemorrhage (7.6%), previous cesarean scar (6.1%), pregnancy-induced hypertension (4.5%), morbidly adherent placenta (4.5%), and antepartum hemorrhage (3.5%). A majority (64.4%) labored for more than 48 hours before hysterectomy.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eIncidence and Indications of OH\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe overall frequency of OH was 0.66% (6.6 per 1000 deliveries). The leading indication was ruptured uterus (81.5%), followed by morbidly adherent placenta (6.2%), postpartum hemorrhage due to uterine atony (4.6%), postpartum uterine sepsis (4.6%), and uterine perforation from unsafe abortion (3.1%). Total abdominal hysterectomy (78.2%) was more common than subtotal hysterectomy (21.6%). The average procedure lasted 2.03 hours (range: 1\u0026ndash;4 hours). (Table 4).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eIntra- and Post-operative Complications\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIntraoperatively, hypovolemic shock occurred in 60% of patients, septic shock in 16.9%, bladder injuries in 15.4% (all repaired), and fistula in 1.5%. Postoperatively, anemia was the most common complication (90.8%), followed by wound infection/dehiscence (27.7%) and sepsis (26.2%).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eMaternal Outcomes\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThere were six maternal deaths (9.2%). Two resulted from multi-organ failure due to septic shock, two from anesthesia complications, and two from cardiorespiratory failure secondary to hypovolemic shock. The majority of patients (70.8%) were discharged within 8\u0026ndash;15 days, 20% within 22 days, and 9.2% within 7 days. Prolonged hospital stay was mainly due to sepsis and wound infection.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFactors Associated with Maternal Outcomes\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eSeveral factors were significantly associated with maternal outcome: (Table 5).\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003e\u003cstrong\u003eAge:\u003c/strong\u003e Women aged 35\u0026ndash;39 years had significantly worse outcomes compared to those under 30 years.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eReferral status:\u003c/strong\u003e Non-referred patients had higher unfavorable outcomes (80%) compared to referred patients (20%).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eANC follow-up:\u003c/strong\u003e Absence of ANC follow-up was strongly associated with unfavorable outcomes (86.8% vs. 13.2%).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHospital stay before operation:\u003c/strong\u003e Patients who stayed \u0026ge;4 hours before surgery had worse outcomes compared to those operated within 4 hours.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDuration of surgery:\u003c/strong\u003e Operations lasting \u0026gt;1 hour were associated with unfavorable outcomes (84.8% vs. 15.2%).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIntraoperative complications:\u003c/strong\u003e Both hypovolemic and septic shock were strongly linked to poor outcomes.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBlood loss and transfusion:\u003c/strong\u003e Patients with severe blood loss and those not transfused had significantly worse outcomes.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDuration of labor:\u003c/strong\u003e Labor \u0026gt;24 hours was associated with unfavorable outcomes (68.2%).\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003e\u003cstrong\u003eMultivariate Logistic Regression\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eFinal analysis identified three independent predictors of unfavorable maternal outcome: (Table 7).\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eLack of ANC follow-up\u003c/strong\u003e \u0026ndash; patients were 7.5 times more likely to have unfavorable outcomes compared to those with ANC visits.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHypovolemic shock during surgery\u003c/strong\u003e \u0026ndash; patients were 16 times more likely to have unfavorable outcomes compared to those without shock.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDuration of surgery \u0026gt;1 hour\u003c/strong\u003e \u0026ndash; patients were 9.5 times more likely to have unfavorable outcomes compared to those operated within 1 hour.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Discussion","content":"\u003cp\u003eObstetric hysterectomy (OH) is a radical, life-saving surgical procedure, most often carried out for life-threatening indications. The most critical surgeon-related factors influencing maternal outcomes are rapid decision-making and timely execution of the surgery [7]. This study was conducted to analyze maternal mortality, morbidity, and associated factors among women who underwent OH at Mettu Karle compressive specialized Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe age of patients ranged from 22\u0026ndash;41 years, with a mean of 30.09 years (SD = 0.61), which is consistent with the study by Lamba \u0026amp; Gupta (mean age = 30.05 years) [16]. The highest frequency was in the 25\u0026ndash;29 year age group (40%), followed by 30\u0026ndash;34 years (24.6%) and 35\u0026ndash;39 years (18.5%). Only 7.7% of patients were between 20\u0026ndash;24 years. This trend is similar to results from Kashani \u0026amp; Azarhoush (2012) [6] and Anita \u0026amp; Kavita (2005), who reported the youngest patient as 22 years and the oldest as 39 years [8]. (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParity ranged from 2\u0026ndash;8 with a mean of 5.18, nearly identical to Ethiopia\u0026rsquo;s rural fertility rate of 5.5 (EDHS, 2011). Most women were multiparous, with 46.6% para 3\u0026ndash;4 and 27.4% para \u0026ge;5. This indicates that OH was most frequent among multiparous women, a finding consistent with Alsayali \u0026amp; Baloul (2000) and Kashani \u0026amp; Azarhoush (2012) [1,4]. The higher incidence among multiparous women is a risk factor widely documented in other studies [8]. (Table 3). (EDHS, 2011) [18]. Similar risk factors were also reported in Taiwan [19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAntenatal Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEffective antenatal care, identification of high-risk patients, adequate transfusion facilities, and improved surgical skills are essential to reducing OH-related morbidity [1]. In this study, 63.1% of patients had no ANC follow-up. Among them, 81.5% experienced unfavorable maternal outcomes. This is comparable with Anita \u0026amp; Kavita (2005), who reported 73.1% unfavorable outcomes in women without ANC [8].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Duration and Experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a strong association between duration of surgery (\u0026gt;1 hour) and unfavorable outcomes (OR = 9.5, 95% CI 1.3\u0026ndash;67.2). Delays were attributed to poor patient condition, shortage of obstetricians, and cases handled by trainee general practitioners. Prolonged anesthesia exposure also contributed. OH performed by experienced surgeons significantly reduces operating time, transfusion requirements, and hospital stay [14]. When conservative treatment fails, OH should not be delayed, as postponement increases blood loss, transfusion needs, operative time, disseminated intravascular coagulation, and ICU admissions [14]. In this study, 41.5% of patients required blood transfusion, though shortages and family refusal to donate blood were major challenges. Comparatively, other studies reported transfusion in 92% of OH cases, with 20% developing coagulopathy [22]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntraoperative Hypovolemic Shock\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHypovolemic shock was strongly associated with maternal outcomes (OR = 16.1, 95% CI 2.1\u0026ndash;120.6). Lack of blood bank services and refusal of family donors were significant contributing factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIncidence of OH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn developed countries, emergency hysterectomy incidence is below 0.1% of deliveries, while in developing countries it ranges between 1\u0026ndash;5 per 1000 [3,6]. The incidence in this study was 6.6 per 1000 deliveries, which is high but comparable to figures reported elsewhere. Ambiye \u0026amp; Venkatraman reported an incidence of 67.8% [9], and global reports range from 0.24\u0026ndash;8.9 per 1000 deliveries [14]. The higher rate here is explained by very low institutional delivery coverage (6.9%) compared to 50% in urban facilities (EDHS, 2011), and the high proportion of referred cases\u0026mdash;95.4% of patients in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndications for OH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe leading indication was uterine rupture (81.5%), higher than the 75% reported by Archana et al. [7]. Causes included previous cesarean scar (4 cases), trauma (1 case), and prolonged labor (64.4%). Most women presented late, often after complications had already occurred, which aligns with Lamba \u0026amp; Gupta (2012) [16]. Prior cesarean section increases OH risk due to placenta previa/accreta and uterine rupture [2].\u003c/p\u003e\n\u003cp\u003eMorbidly adherent placenta (6.2%) was the second most common indication. Similar findings were reported in other studies [2,4,5], though at higher rates (16\u0026ndash;28%). The lower incidence in this study is likely due to the predominance of uterine rupture. Other less frequent indications included postpartum hemorrhage from uterine atony (4.6%), postpartum sepsis (4.6%), and uterine perforation from destructive delivery (3.1%). These figures are comparable to Kashani \u0026amp; Azarhoush (2012) [4] and Anita \u0026amp; Kavita [8].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal Mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were six maternal deaths (9.2%), consistent with Ambiye \u0026amp; Venkatraman\u0026rsquo;s findings (9.3%). Causes included irreversible hemorrhagic shock due to ruptured uterus (2 cases), cardiorespiratory failure related to anesthesia (2 cases), and multi-organ failure secondary to septic shock (2 cases). The rest were discharged: 70.8% within 8\u0026ndash;15 days, 20% within 16\u0026ndash;22 days, and 9.2% within 7 days. Prolonged stays were primarily due to sepsis and wound infections. Similar causes of death and complications were reported by Lamba \u0026amp; Gupta (2012) [16]. Proper timing of OH and meticulous perioperative care may reduce complications such as coagulopathy, severe hypovolemia, tissue hypoxia, hypothermia, and acidosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eType of Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTotal hysterectomy was the most frequently performed procedure (76.7%). While subtotal hysterectomy is often preferred in unstable patients due to being faster and less hemorrhagic, total hysterectomy is recommended because of risks associated with leaving the cervical stump, including malignancy and persistent bleeding [6,8,16]. In this study, the choice was likely based on surgeon experience and patient condition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntraoperative and Postoperative Complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHypovolemic shock (24.6%) was the most common intra operative complication, followed by septic shock (10.9%). Both were significantly associated with poor outcomes (OR = 16.1, 95% CI 2.1\u0026ndash;120.6). Bladder injuries occurred in 15.4% of cases, and one fistula (1.5%) was reported; all bladder injuries were repaired. These findings are consistent with Tallab Fassil (16%) [7]. Comparable findings were also reported in previous studies [21].\u003c/p\u003e\n\u003cp\u003ePostoperative complications included anemia (90.8%), sepsis (26.2%), and wound infection or dehiscence (27.7%). These rates are consistent with findings by Lamba \u0026amp; Gupta (2012) and Tallab Fassil [7,16]. Other studies (Naureen Javed and Sumera Tahir) also report sepsis and wound infection as leading postoperative complications, often linked to massive hemorrhage and hypovolemic shock [6,12]\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eStrength of the Study\u003c/strong\u003e\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003eAs to my knowledge this research is the first research performed in the hospital to this area of interest\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2 id=\"_Toc482412356\"\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/h2\u003e\n\u003cul\u003e\n \u003cli\u003eTime constraints\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVery low institutional delivery rate at the Hospital\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe incidence of obstetric hysterectomy (OH) at Mettu Karle compressive specialized Hospital was found to be high, with uterine rupture being the leading indication. All cases of uterine perforation secondary to destructive delivery required OH, and the most common procedure performed was total abdominal hysterectomy. The major complications encountered were hypovolemic shock and postoperative sepsis. Longer preoperative hospital stay (\u0026gt;4 hours) [COR=7.5, 95% CI: 2.64\u0026ndash;21.28, p=0.000] and septic shock [COR=16.1, 95% CI: 2.1\u0026ndash;120.6, p=0.007] were significantly associated with maternal death. There were six maternal deaths: four due to multi-organ failure from hypovolemic and septic shock, and two related to anesthesia complications. Overall, OH remains a life-saving intervention, but favorable outcomes depend on promptdecision-making, skilled surgical care, effective maternal health services, active labor management, early recognition of complications, and timely referral..\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/hw\u003e\n\u003cp\u003eThe study recommends improving proper chart keeping and documentation, ensuring early recognition and management of complications, and strengthening antenatal care with timely referral of high-risk cases. Emergency obstetric care should be expanded, with Basic EmOC available at health centers and Comprehensive EmOC, including caesarean sections and blood transfusions, at district hospitals. Additionally, upgrading peripheral health services, improving transportation, providing refresher training, and deploying skilled professionals in rural areas are essential.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eANC\u0026nbsp;\u003c/strong\u003eAntenatal Care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAPH\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ante Partum Hemorrhage\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBEmOC\u0026nbsp;\u003c/strong\u003eBasic Emergency Obstetric Care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBSC\u0026nbsp;\u003c/strong\u003eBachelor of science\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCEmOC\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Comprehensive Emergency Obstetric Care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCD\u0026nbsp;\u003c/strong\u003eCaesarean Delivery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDIC\u0026nbsp;\u003c/strong\u003eDisseminated Intravascular Coagulopathies\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmOC\u0026nbsp;\u003c/strong\u003eEmergency Obstetric Care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEDHS\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ethiopian Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOH\u0026nbsp;\u003c/strong\u003eObstetric Hysterectomy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGA\u0026nbsp;\u003c/strong\u003eGestational Age\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGTD\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gestational Trophoblastic Disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Human Immune Deficiency Virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICU\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Intensive Care Unit\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIEOS\u0026nbsp;\u003c/strong\u003eIntegrated Emergency Obstetrics and Gynecology and General Surgery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLUSCD\u0026nbsp;\u003c/strong\u003eLower uterine Segment Caesarian Delivery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMMR\u0026nbsp;\u003c/strong\u003eMaternal Mortality Ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMRI\u0026nbsp;\u003c/strong\u003eMagnetic Resonant Imaging\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMD\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Medical doctor\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNGO\u0026nbsp;\u003c/strong\u003eNon Governmental Organization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Operating room\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePGE2\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Prostaglandin group E2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePPH\u0026nbsp;\u003c/strong\u003ePost Partum Hemorrhage\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eData are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis study was self-funded.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eDagim Dagne is the sole author. The author read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe author thanks Mattu University, Mettu Karle compressive specialized hospital \u0026nbsp;and data collectors for their support. Special gratitude to study participants for their invaluable contributions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlsayali ARA, Baloul SMA. EMERGENCY OBSTETRIC HYSTERECTOMY: 8-YEAR REVIEW AT TAIF MATERNITY HOSPITAL, SAUDI ARABIA. Ann. Saudi Med. 2000;20(June):454\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKorejo R, Nasir A, Yasmin H, Bhutta S. Original Article Emergency Obstetric Hysterectomy. J Pak Med Assoc. 2012;64(12):1322\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaskett TF. Peripartum Hysterectomy. 2010;462\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKashani E, Azarhoush R. Peripartum hysterectomy for primary postpartum hemorrhage: 10 years evaluation. Eur J Exp Biol. 2012;2(1):32\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShaikh NB, Shaikh S, Shaikh JM. MORBIDITY AND MORTALITY ASSOCIATED WITH OBSTETRIC HYSTERECTOMY. J Ayub Med Coll Abbottabad. 2010;22(2):100\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUmezurike CC, Adisa CA. Peripartum Hysterectomy. 2012. pp. 96\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTallab F, Helewa M. PERIPARTUM HYSTERECTOMY: 10-YEAR EXPERIENCE IN TWO MANITOBA CENTERS. Ann. Saudi Med. 1998;18(5):398\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnita K, Kavita W. Emergency obstetric hysterectomy. J Obs Gynecol India. 2005;55(2):132\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiddiq N, Ghazi A, Jabbar S, Al T. EMERGENCY OBSTETRICAL HYSTERECTOMY (EOH): A LIFE SAVING PROCEDURE IN OBSTETRICS. pakistan J Surg. 2007;23(3):217\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarolyn Metal. Emergency peripartum hysterectomy. 1993. p. Pages 1443\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaskalakis G1, Anastasakis E, Papantoniou N, Mesogitis S, Theodora M AA. Emergency obstetric hysterectomy. Acta Obs. Gynecol Scand. 2007;;86((2))::223\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRita Thaker MD], [Rabia Khurshid MD. ], [Abida Ahmad M. Emergency Peripartum Hysterectomy A 10-Year Review. J. Med. Sci. 2012. 2012;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKwakye AK, Seffah JD, PERIPARTUM HYSTERECTOMIES AT THE KORLE-BU, TEACH-. ING HOSPITAL: A REVIEW OF 182 CONSECUTIVE CASES. Ghana Med. J. 2007;41(3):133\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMachado LSM. Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome. N Am J Med Sci. 2011;3(8):6\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee RH, et al. Emergency Postpartum Hysterectomy for A Systematic Review. Obs Gynecol. 2010;115(3):637\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLamba J, Gupta S. Role of Emergency Hysterectomy in Modern Obstetrics. JK Sci. 2012;14(1):22\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaqvi KZ, Thontia S. Peripartum Hysterectomy. J Surg Pakistan. 2013;18(June):97\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEthiopia. Demographic and Health Survey Preliminary Report. 2011.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang M, Wang P. Peripartum Hysterectomy Risk Factors in Taiwan. J Chin Med Assoc. 2010;73(8):399\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNnadi EN. and D. Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto, Nigeria. Ann Med Heal Sci Res; 2((1)):: 37\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePERVEEN F, et al. Original Article PERIPARTUM HYSTERECTOMY FOR PRIMARY. Q Med Channel. 2012;19(3):34\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasheer S, Najmi N. Peripartum Hysterectomy Versus Non Obstetrical Hysterectomy.Hosp. J Chin Med Assoc. 2010;;73((7))::360\u0026ndash;363.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e: Data of obstetric interventions at Mettu Karle compressive specialized Hospital from April 2018-April 2025 GC\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp id=\"_Toc481116354\"\u003e\u003cstrong\u003eMode of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan id=\"_Toc481116355\"\u003e\u003cstrong\u003eNumber (N)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan id=\"_Toc481116356\"\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e9153\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e92.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLaparatomy + CD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e657\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eObstetric hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e65\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal number of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e9875\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1: Distribution of obstetric interventions at Mettu Karle Comprehensive Specialized Hospital, April 2018\u0026ndash;April 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: Age wise distribution of patients who undergone OH at Mettu Karle compressive specialized Hospital for the indication of obstetrics hysterectomy from April 2018- April 2025 G.C\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"496\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of pts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e92.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2: Age-wise distribution of patients who underwent obstetric hysterectomy at Mettu Karle Comprehensive Specialized Hospital, April 2018\u0026ndash;April 2025.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc518037839\"\u003eTable 3: Obstetric profile of the patients undergone obstetric hysterectomy at Mettu Karle compressive specialized Hospital from April 2018- April 2025(n=65).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber(N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\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\"\u003e\n \u003cp\u003eGestational age in \u0026nbsp;weeks\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37-42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e81.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;=5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMother came with referral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDistance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e˂100kms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;100kms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDuration of hospital stay before operation in hrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026le;4hrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;4hrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMode of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLaparatomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eANC follow up visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3: Obstetric profile of patients who underwent obstetric hysterectomy at Mettu Karle Comprehensive Specialized Hospital, April 2018\u0026ndash;April 2025.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc518037840\"\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eIndication for OH at Mettu Karle compressive specialized Hospital from April 2018- April 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntra operative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eSeptic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eHypo volumic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eNo complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e64.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eWound infection and or dehiscence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eAnemia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e90.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eNo complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4: Indications for obstetric hysterectomy at Mettu Karle Comprehensive Specialized Hospital, April 2018\u0026ndash;April 2025.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5: Bivariate logistic regression of socio demographic factors with maternal outcome of OH \u0026nbsp; (N=65) at Mettu Karle compressive specialized Hospital from April 2018- April 2025\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"659\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp id=\"_Toc518037842\"\u003e\u003cstrong\u003eS no\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003evariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal \u0026nbsp; \u0026nbsp;outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFavorable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnfavorable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e11.3(1.1-112.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e480()\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComes with referral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e22 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e. 024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.2 (1.2- 14.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eANC follow up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e19(70.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e33(86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.7(4.5-54.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 470px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5: Bivariate logistic regression of socio-demographic factors with maternal outcomes among women undergoing obstetric hysterectomy (N=65), April 2018\u0026ndash;April 2025.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eBivariate logistic regression analysis of\u0026nbsp;socio-demographic\u003cem\u003e\u0026nbsp;\u003c/em\u003efactors\u0026nbsp;risk factors for maternal\u0026nbsp;outcome\u0026nbsp;in\u0026nbsp;underwent OH \u0026nbsp; \u0026nbsp;(N=65)\u0026nbsp;at\u0026nbsp; Mettu Karle compressive specialized Hospital from April 2018- April 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"960\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eS no\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ev\u003c/strong\u003e\u003cstrong\u003eariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMaternal \u0026nbsp; \u0026nbsp; \u0026nbsp; outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCOR(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFavorable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnfavorable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.3(1.1-112.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e480()\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComes with referral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e. 024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.2 (1.2- 14.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eANC follow up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19(70.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33(86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.7(4.5-54.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6: Bivariate logistic regression analysis of socio-demographic risk factors associated with maternal outcomes in obstetric hysterectomy cases (N=65), April 2018\u0026ndash;April 2025.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u0026nbsp;\u003c/strong\u003eMultivariate logistic regression analysis of risk factors for maternal outcome who underwent OH \u0026nbsp; (N=65) at Mettu Karle compressive specialized Hospital from April 2018- April 2025\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSN\u003cu\u003eo\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% of CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003efavorable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eunfavorable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eANC FOLLOW UP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15.7(4.5-54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.4\u0026nbsp;(1.2-70.95)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24(77.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7(22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHypo-volumic shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21(80.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5(19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.100(2.8,29.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.1 (2.2-119.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26(68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDuration of procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;1hr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22(68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10(31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;1hr\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5(15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28(84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.44 (3.4,38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.5 (1.3-67.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 7: Multivariate logistic regression analysis of risk factors for maternal outcomes among women who underwent obstetric hysterectomy (N=65), April 2018\u0026ndash;April 2025.\u003c/p\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-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency Obstetric Hysterectomy, Incidence, Maternal death, complication and associated risk factors","lastPublishedDoi":"10.21203/rs.3.rs-7582759/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7582759/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eObstetric hysterectomy is indicated when patient's life is at risk, related to significant maternal mortality and morbidity and it is also a potentially lifesaving procedure. In developed countries, the reported incidence of emergency hysterectomy is below 0.1% of the total normal deliveries performed, while in developing countries, the incidence rates are as high as 1-5/ 1000 of all the deliveries performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe aim of the study was to estimate incidence, indications, risk factors and operative morbidity and mortality in pregnant women undergoing obstetric hysterectomy (OH) in seven years at Mettu Karle comprehensive specializedHospital: from April 2018 to April 2025 GC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and Materials\u003c/strong\u003e: A facility based retrospective cross sectional review of obstetric records was obtained over a period of seven years (April 2018 to April 2025 GC). Study was conducted from October 2018 to June 2025 GC. All women treated at Mettu Karle comprehensive specialized Hospital for the indication of obstetrics hysterectomy were included in the study. Data was collected with structured format. Results were analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0. For all statistical significance tests the cut off value set is P\u0026lt;0.05 and binary logistic regressions will use to estimate the crude odds ratios of maternal outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/em\u003eThere were a total of 8657 confinements and 65cases of OH was undertaken during the study period to give an incidence of 6.6/1000 deliveries with a maximum numbers of patients (n=20, 27.4 %) in the age group of \u0026gt;35yrs and parity of 3-4 (46.5%). Ruptured uterus (n=55, 75.3%), atonic PPH (n=6, 8.2%).), post partal sepsis and perforated uterus secondary to unsafe abortion (n=4, 5.5%) were the commonest causes for this life saving surgery. Out of the 65 hysterectomies performed, 56 (76.7%) were total hysterectomy and 17(23.3%) were subtotal hysterectomy. There were six maternal deaths (9.2%).Duration of hospital stay \u0026gt;4 hrs before operation (OR=7.5, CI=2.64-21.28) were statistically associated with maternal death.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendation\u003c/strong\u003e: The incidence of OH and maternal death in Mettu Karle comprehensive specializedHospital was high. Good maternal care, ANC follow up, active management of labor, early recognition of complications and timely referral will go a long way in ensuring for a better outcome.\u003c/p\u003e","manuscriptTitle":"Assessment of prevalence, indications, outcomes and post operative complications of obstetric hysterectomy: at Mettu karel comprehensive specialized hospital, Mettu, south weast, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 04:18:57","doi":"10.21203/rs.3.rs-7582759/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-14T20:31:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-14T14:22:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T21:13:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T17:09:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213253285897786754494850439324007121160","date":"2026-03-15T08:09:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T12:20:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71811710196455501570657972498242685348","date":"2026-03-13T12:18:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64607056901279381030908557607467958909","date":"2026-03-12T20:27:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T15:57:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176094099049967519560894825174942544776","date":"2026-03-09T14:47:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70500526739709142109770152687681140850","date":"2026-03-07T03:04:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228276382073676875292032781289694742282","date":"2026-03-06T23:52:50+00:00","index":"hide","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-09T18:07:04+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T10:25:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-12T10:16:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-12T10:12:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-10T12:05:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d06ab7bf-c5fb-4779-9e49-bbe6eed86966","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T23:08:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 04:18:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7582759","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7582759","identity":"rs-7582759","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}