Comparison of Maternal and Perinatal Outcomes in Elective and Emergency Cesarean Hysterectomies: A Prospective Observational Study

Objective: Comparing maternal and perinatal outcomes in emergency cesarean hysterectomies with elective cesarean hysterectomies. Materials and methods: “Prospective observational study” conducted at two centers in India from July 2018 to June 2022. Results: About 45 patients underwent cesarean hysterectomy. Out of this, 26.7% underwent elective CH and 73.3% underwent emergency CH. “Placenta accreta” was the most common and the only cause for elective CH (100%) whereas the most common cause for emergency CH was found to be atonic PPH (72.7%) which was followed by ruptured uterus (27.3%). The average duration of surgical procedure was much higher in the emergency CH compared with emergency CH group (177.73 ± 5.88 minutes vs 118.75 ± 4.33 minutes; p < 0.001). ICU care was required in 90.9% patients of emergency CH patients in comparison with 25% of patients who had elective CH (p-value of 0.002). Patients who underwent emergency CH required massive blood transfusions much more frequently (100%) than those who underwent elective CH (25%), (p < 0.001). Duration of stay in ICU in patients who underwent emergency CH was much more compared with elective CH (9.00 ± 3.40 days vs 3.40 ± 4.39 days), (p < 0.001). Severe maternal morbidities were more common in patients who underwent emergency CH (100 vs 25%; p < 0.001). Maternal death was more prevalent in emergency CH when compared with elective CH (18.2% vs zero; p-value of 0.113). Intraoperative bladder injury was seen in 50% of patients who underwent elective CH (p < 0.001). Stillbirth was more common in emergency CH (54.5% vs zero; p-value of 0.001). Babies born with poor APGAR score at 1 minute were much more in emergency CH (100% vs zero; p-value of 0.001). Conclusion: Elective CH has far less adverse maternal and neonatal outcomes. Whenever adverse outcomes are anticipated with cesarean, it is highly advisable to be prepared for an elective CH.