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Hemostasis Hysterectomies in a Low Resources Country: Epidemiological, Clinical, and Therapeutic Aspects

Background: The perilous path of the African woman’s pregnancy often ends in difficult situations putting her life in danger. One of the solutions to save her is often to “remove” her uterus, in a hemorrhage and emergency context. It is the hemostasis hysterectomy. It’s generally practiced in difficult conditions with complicated operative follow-ups. The tragedy is that finally the patient will die (almost 1 time out of 2 in our study). This is the sad reality of resource-limited countries. How many women will continue to die under these conditions? This study attempts to explore the different aspects of this reality. Objective: To study the epidemiological, clinical, and therapeutic aspects of hemostasis hysterectomies at the Teaching Hospital of Souro Sanou University Hospital in Burkina Faso. Methodology: This was a prospective cross-sectional descriptive study conducted over 12 months from January 1 to December 31, 2015. Included in our study were all patients received in our department and who required a total or subtotal hysterectomy in the management of a severe postpartum hemorrhage, during the study period. Results: The frequency of hemostasis hysterectomies was 0.4% compared to all deliveries. The average age was 29.65 years old. The average parity was 4.3. Multiparas and large multiparas accounted for 65%. The main indications were uterine rupture (40%) and uterine inertia (60%). Hysterectomy was subtotal in 95% of cases. Maternal morbidity was dominated in 90% of cases by hemorrhagic shock, hemostatic disorders, and obstetrical fistulas. The prognosis was poor, with 8 deaths or 40% of cases. Conclusion: Better management of pregnancy and childbirth would reduce cases of hemostasis hysterectomies. The availability of blood products would improve the maternal prognosis.