INCIDENCE AND RISK FACTORS OF OBSTRUCTED LABOR LEADING TO EMERGENCY HYSTERECTOMY IN PAKISTAN: A RETROSPECTIVE STUDY

Abstract

Background: Obstructed Labor continues to be the major cause of maternal morbidity and mortality in low resource settings. Delays in referrals and the improper care provided by unqualified birth attendants, like lady health visitors and traditional birth attendants (Dais), play a significant role in negative outcomes in Pakistan. Emergency hysterectomy can be lifesaving, it often has devastating impacts on reproductive health and overall quality of life.

Methods: This retrospective study reviewed records from Women & Children Teaching Hospital, D.I. Khan, from July 2020 to August 2025. Data were analyzed using SPSS version 25, with descriptive statistics presented as numbers and percentages. The study included all women who underwent emergency hysterectomy due to obstructed labor or uterine rupture. Data on demographics, labor characteristics, referral delays, and intraoperative findings were collected and analyzed.

Results: During the study period, there were 47,405 deliveries, of which 125 women (0.26%) required emergency hysterectomy due to obstructed labor. All patients were initially managed by unqualified LHVs or dais before referral. The majority (89%) presented after >12 hours of obstructed labor, and 84% had injudicious oxytocin augmentation prior to referral. Grand multiparity (88.8%), teenage pregnancy (10%), and cephalopelvic disproportion (82%) were common risk factors. Uterine rupture was the most frequent intraoperative finding (68%), followed by atonic uterus unresponsive to medical management (32%). The maternal mortality rate was 18%, while perinatal mortality reached 55%.

Conclusion: Obstructed Labor leading to emergency hysterectomy remains worryingly common in Pakistan, however it is largely preventable through timely and skilled obstetrical care. Unqualified Lady health visitors and traditional birth attendants is the major determinant for this mismanagement. This can be overcome by strengthening regulation of unskilled providers, community education and improving the referral system.