Hysterectomy: still a treatment of choice for pelvic pathologies in rural India

Background: Hysterectomy has always been a subject of controversy in India and increasing rate of unnecessary hysterectomies in young, premenopausal women is cause for concern regarding women’s health and rights. The aim of this study is to review and analyse cases of hysterectomy in a rural population and to correlate with underlying factors behind seeking hysterectomy as a treatment of choice for pelvic pathologies.Methods: This was an ambidirectional observational descriptive study in which 352 women were included who underwent hysterectomy between January 2016 to July 2017 in the Department of Obstetrics and Gynecology, Government Medical College Rajnandgaon and a tertiary care referral hospital of central Chhattisgarh, India.Results: Majority were between 31-50 years of age group, grandmultipara, uneducated, insured by National health insurance scheme.76.1% patients had attended medical college hospital to avail free services. 60.5% took prior treatment from unqualified/ unregistered/registered general practitioners. Erratic use /use of suboptimal dosage of hormones to stop abnormal uterine bleeding, nonspecific antibiotics to treat infection, incomplete treatment and poor compliance were possible reasons behind failure of previous treatments. Abnormal menstruation was the commonest presenting complaint observed in 75.2%. 72.4% patients refused to come for follow up and reasons were unavailability of transport facility, fear of losing job, loss of daily wages and financial constraints. Commonest indication for hysterectomy was symptomatic fibroid in 32.0%. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was the most common procedure done in 59.0%. The rate of hysterectomy came out to be 57.6% which is quite higher than that reported in other studies. Fever was the most common complication encountered in 0.80%.Conclusions: Despite the remarkable improvement in conservative management and media coverage, hysterectomy still remains the most preferred modality of treatment with excellent satisfaction for pelvic pathologies in rural India