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\title{Clinical Trends, Indications, Postoperative Complications of Hysterectomy Patients-A Retrospective Study}
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\begin{document}

             \author[1]{Dr. Tushar T  Palve}

             \author[2]{Dr. Mridula  Raghav}

             \affil[1]{  Grant Government medical college and Sir J.J group of hospitals, Mumbai, Maharashtra, India}

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\date{\small \em Received: 13 December 2018 Accepted: 31 December 2018 Published: 15 January 2019}

\maketitle


\begin{abstract}
        


Background: Hysterectomy is today a relatively safe routine operation performed commonly worldwide done in women next only to cesarean delivery. Our study aims to know the clinical profile, indications, post-operative complications of patients who underwent an abdominal hysterectomy.Methods: This is the retrospective study of 41 cases of abdominal hysterectomy done for benign conditions of the uterus. The study period was from August 2018 to January 2019 at tertiary care hospital, Mumbai. We chose women who underwent abdominal hysterectomy in the period 6 months irrespective of their age, parity or clinical presentation. Results:The study group had women between 35-65 years. 46.3% belonged to 45-50 years of age. Majorly, hysterectomy was performed in para two and para three cases. Most common complaint was abnormal menstrual flow (70.7%). Commonest indication for hysterectomy was Fibroid (56%) and DUB (26.8%).

\end{abstract}


\keywords{hysterectomy, mumbai, clinical profile, fibroid, menorrhagia.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
ysterectomy is today a relatively safe routine operation performed commonly. In India, only extrapolated figures are available based on international data base 2004. According to this, out of 1,065,070,607 women, 2,310,263 have had hysterectomy (2.16/1,000 women) \hyperref[b0]{(1)}. The rate of hysterectomy in India seems to be on the rise.\par
The common indication of hysterectomy are fibroid uterus, dysfunctional uterine bleeding (DUB), prolapsed genital organ, etc. The various techniques and approaches include abdominal, vaginal, and laparoscopy. The lifetime risk of hysterectomy ranges rate of concurrent oophorectomy with this procedure because of the early menopause that ensues specially in the premenopausal women. Although hysterectomy is the definitive treatment for many conditions, it is not risk-free. It is associated with the risk of iatrogenic Author ? ?: Grant Government Medical College and Sir J.J Group of Hospitals, Mumbai, Maharashtra, India. e-mails: fabulousmridula@gmail.com, drmridularaghav@hotmail.com premature menopause, surgical and anesthetic complications. Hence an audit is mandatory to evaluate the indications of hysterectomy. This study of 41 cases of abdominal hysterectomies for the benign condition of uterus has been taken to study the clinical profile, indications, complaints, and complications. In response to the consistent demand for this procedure, recent reports have identified hysterectomy as a key health indicator used to measure and compare hospital performances \hyperref[b0]{(1)}. The present study attempts to analyze the trend of abdominal hysterectomy over the past six months in a tertiary care centre at Mumbai, India. 
\section[{II.}]{II.} 
\section[{Methods}]{Methods}\par
This is a retrospective study done from August 2018 to January 2019, in the department of obstetrics and gynecology, attertiary care hospital, Mumbai, India. Data collected were analyzed using descriptive statistics based on the parameters of age, parity, complaints, indications, complications and presented in percentages. 
\section[{III.}]{III.} 
\section[{Results}]{Results}\par
41women who had undergone abdominal hysterectomy for benign conditions of the uterus were studied attertiary care hospital, Mumbai, India between August 2018 to January 2019.  IV. 
\section[{Discussion}]{Discussion}\par
In this study on 41 hysterectomy cases, a few observations were read regarding the anthropometric data, clinical presentation, indications, postoperative complication study observations are described below.\par
We divided the patients into six groups depending on their age. Most common age group was between 45-50 years , and similar reports were also given by  {\ref Sucheta KL et}  So, in our study dysfunctional uterine bleeding and Leiomyoma were found to be the main indications for hysterectomy and similar reports were observed in other series also. Seven of the patient had hypertension, two patients had hypothyroidism, and one patient had bronchial asthma. 36.5\% of the patient had associated bilateral salpingo-oophorectomy, 19.05 \% had associated right salpingo-oophorectomy, and 21.9\% had associated left salpingo-oophorectomy. 4.8 \% of patient had subtotal hysterectomy; subtotal hysterectomy was done because of adhesion and difficult tubo-ovarian mass. In our study following complications are noted:\par
Post-operative wound infection occurred in 5 cases comprising 12.1\% of cases. Hemorrhage: Blood transfused to patients in intra operative or post-operative period is included in this category. Eight patients out of 41 cases required one or more pints of blood either intraoperatively or postoperatively. That means 19.5\% of cases required one or more pints of blood either intraoperatively or postoperatively. We observed wound dehiscence in three cases which needed re-suturing of the wound (7.3\%). Miscellaneous: Urinary bladder rent seen in one case.  V. 
\section[{Conclusion}]{Conclusion}\par
Hysterectomy will remain a common gynecological operation in both developing and developed countries. Women aged between 45-50 years with multiparous status were commonly affected. Abnormal menstrual flow was the most common presenting complaint. Commonest indications for hysterectomy were fibroid and dysfunctional uterine bleeding. We found no mortality in this study. \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.6003496503496503\textwidth}P{0.24965034965034963\textwidth}}
Age\tabcellsep Percentage\\
35-40\tabcellsep 9.7\%\\
40-45\tabcellsep 26.8\%\\
45-50\tabcellsep 46.3\%\\
50-55\tabcellsep 9.7\%\\
55-60\tabcellsep 4.8\%\\
60-65\tabcellsep 2.4\%\\
\multicolumn{2}{l}{Majorly, hysterectomy was performed in para}\\
two and para three cases.\tabcellsep \end{longtable} \par
  {\small\itshape [Note: H]} 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.61625\textwidth}P{0.23375\textwidth}}
Complaints\tabcellsep Percentage\\
Abnormal uterine bleeding\tabcellsep 70.7 \%\\
Pain\tabcellsep 9.7\%\\
Genital organ prolapse\tabcellsep 12.1\%\\
Postmenopausal bleeding PV\tabcellsep 7.3\%\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.7248062015503876\textwidth}P{0.1251937984496124\textwidth}}
Indications\tabcellsep Percentage\\
DUB\tabcellsep 26.8 \%\\
Fibroid\tabcellsep 56 \%\\
Adenomyosis\tabcellsep 9.7\%\\
Prolapse\tabcellsep 4.8\%\\
Polyp\tabcellsep 2.4 \%\\
\multicolumn{2}{l}{Febrile morbidity, hemorrhage, wound infection}\\
\multicolumn{2}{l}{and urinary tract infection was commonly encountered}\\
\multicolumn{2}{l}{complications after a hysterectomy. No mortality was}\\
seen in 41 cases studied.\tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
Sucheta K L et al. (\\
al. (3), Watts et al. (2) reported\\
that 45.2\% of hysterectomies were done between\\
41-50years,Sivapragasam V et al. (4) reported 52.5\%. In\\
this series, no women were nulliparous whereas\\
Sucheta KL et al. only 5\% of women were nulliparous,\\
Sivapragasam V et al. 2 \%.So we can say that parity has\\
got a definite role to play.\\
The patient presented with the various\\
symptom. The main complaint was abnormal menstrual\\
flow in 70.7\% of cases, pain abdomen 9.7\%, prolapse\\
12.1\% of cases, post-menopausal bleeding 7.3\%. It was\\
observed that the single most complaint was abnormal\\
menstrual flow comprising of 70.7\% of cases. Similarly\end{longtable} \par
 
\caption{\label{tab_3}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.12966101694915255\textwidth}P{0.3140677966101695\textwidth}P{0.1959322033898305\textwidth}P{0.21033898305084747\textwidth}}
Parameters\tabcellsep Our Study\tabcellsep Sucheta KL et al\tabcellsep Sivapragasam V et al\\
Age group\tabcellsep 45-50 yrs (46.3 \%)\tabcellsep 41-50 yrs (50\%)\tabcellsep 41-50 yrs (52.5\%)\\
Parity\tabcellsep All multiparous\tabcellsep 5 \% Nulliparous\tabcellsep 2\% Nulliparous\\
Complaints\tabcellsep AUB (70.7 \% ) Prolapse (12.1 \% )\tabcellsep 62 \% 24\%\tabcellsep 28\% 16 \%\\
Indication\tabcellsep Fibroid ( 56 \% ) DUB (26.8 \% )\tabcellsep 23 \% 33\%\tabcellsep 21 \% 28\%\end{longtable} \par
 
\caption{\label{tab_4}Table 4}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[Sivapragasam et al. ()]{b3}\label{b3} 	 		‘An audit of hysterectomies: indications, complications and clinico pathological analysis of hysterectomy specimens in a tertiary care center’.  		 			V Sivapragasam 		,  		 			C K Rengasamy 		,  		 			A Patil 		.  	 	 		\textit{Int J Reprod Contracept Obstet Gynecol}  		2018. 7 p. .  	 
\bibitem[Watts ()]{b1}\label{b1} 	 		‘Clinical profile of adenomyosis’.  		 			Kimbrough Watts 		.  	 	 		\textit{J Obst Gyn}  		1956. 7 p. 483.  	 
\bibitem[Sucheta et al. ()]{b2}\label{b2} 	 		‘Hysterectomy: clinical profile, indications and postoperative complications’.  		 			K L Sucheta 		,  		 			M Manangi 		,  		 			K P Madhu 		,  		 			B J Arun 		,  		 			N Nagaraj 		.  	 	 		\textit{Int J Reprod Contracept Obstet Gynecol}  		2016. 5 p. .  	 
\bibitem[Perveen et al. ()]{b4}\label{b4} 	 		‘Pattern of lesion in hysterectomy specimens and clinical correlation’.  		 			S Perveen 		,  		 			A Ansari 		,  		 			F Naheed 		,  		 			A Sultana 		.  	 	 		\textit{Pak J Med H S}  		2014. 8  (2)  p. .  	 
\bibitem[Bala et al. ()]{b0}\label{b0} 	 		‘Trend of hysterectomy: A retrospective analysis in Regional Institute of Medical Sciences (RIMS)’.  		 			R Bala 		,  		 			K P Devi 		,  		 			C M Singh 		.  	 	 		\textit{J Med Soc}  		2015. 29 p. 47.  	 
\end{bibitemlist}
 			 		 	 
\end{document}