Audit of pre-hysterectomy medical treatment

Nilesh Chavda, Shruti Tailor, Ragini Verma
International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2023 · vol. 12(5) , pp. 1366–1369 · doi:10.18203/2320-1770.ijrcog20231225 · W4367369308
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This observational study of 72 women undergoing hysterectomy found that only 47% received prior medical treatment, with higher rates for endometriosis and adenomyosis than fibroids, indicating inadequate trial of conservative management.

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This observational audit evaluated the prevalence of prior medical treatment among 72 women undergoing hysterectomy for benign gynecological conditions at a tertiary care center over one year. The study found that only 47% of patients received prior medical management, with significantly higher rates observed in those with endometriosis and adenomyosis compared to those with fibroids. The authors conclude that pre-hysterectomy counseling regarding conservative medical options is inadequate and requires improvement to better address patient perspectives and resistance. Relevance to endometriosis: explicitly studied as an indication for hysterectomy where 100% of subjects had prior treatment; Relevance to adenomyosis: explicitly studied as an indication where 68.75% of subjects had prior treatment.

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Abstract

Background: Variations in rates of hysterectomy have been observed and have been associated with women demographic characteristics such as race, socio-economic status, educational status and geographic location. However, with the advent of novel medical and conservative measures, there are doubts on justification of hysterectomy. Aims and objectives were to study prior treatment taken with respect to clinical profile in women undergoing hysterectomy in a tertiary care centre. Methods: An observational study was conducted by collecting data from medical records of 72 consenting subjects undergoing hysterectomy for benign gynaecological reasons in a tertiary care centre over a period of 12 months after ethics approval. Results: Out of 72 subjects, only 34 subjects (47.22%) had taken a prior medical treatment before undergoing hysterectomy. 100% of the subjects with endometriosis, chronic PID and DUB had taken some form of prior treatment whereas 27.5% of subjects with fibroid and 68.75% of subjects with adenomyosis had taken prior treatment. Conclusions: Our study indicates that prior medical management is not being adequately discussed and trialled among women undergoing hysterectomy. Hence, improving the counselling and understanding the women’s perspective for resistance towards medical management is an important area for research in improving quality of health care.
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Background

Variations in rates of hysterectomy have been observed and have been associated with women demographic characteristics such as race, socio-economic status, educational status and geographic location. However, with the advent of novel medical and conservative measures, there are doubts on justification of hysterectomy. Aims and objectives were to study prior treatment taken with respect to clinical profile in women undergoing hysterectomy in a tertiary care centre.

Methods

An observational study was conducted by collecting data from medical records of 72 consenting subjects undergoing hysterectomy for benign gynaecological reasons in a tertiary care centre over a period of 12 months after ethics approval.

Results

Out of 72 subjects, only 34 subjects (47.22%) had taken a prior medical treatment before undergoing hysterectomy. 100% of the subjects with endometriosis, chronic PID and DUB had taken some form of prior treatment whereas 27.5% of subjects with fibroid and 68.75% of subjects with adenomyosis had taken prior treatment.

Conclusions

Our study indicates that prior medical management is not being adequately discussed and trialled among women undergoing hysterectomy. Hence, improving the counselling and understanding the women’s perspective for resistance towards medical management is an important area for research in improving quality of health care. Metrics

References

Hammer A, Rositch AF, Kahlert J, Gravitt PE, Blaakaer J, Søgaard M. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. Am J Obstet Gynecol. 2015;213(1):23-9. Desai S, Shukla A, Nambiar D, Ved R. Patterns of hysterectomy in India: a national and state‐level analysis of the fourth national family health survey (2015-2016). BJOG. 2019;126:72-80.. Stewart EA, Shuster LT, Rocca WA. Reassessing hysterectomy. Minnesota Med. 2012;95(3):36. Singh A, Govil D. Hysterectomy in India: Spatial and multilevel analysis. Women’s Health. 2021;17:17455065211017068. Broder MS, Kanouse DE, Mittman BS, Bernstein SJ. The appropriateness of recommendations for hysterectomy. Obstet Gynecol. 2000;95(2):199-205. Desai S, Campbell OM, Sinha T, Mahal A, Cousens S. Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India. Health Polic Plan. 2017;32(1):68-78. Shekhar C, Paswan B, Singh A. Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India. Reprod Health. 2019;16:1-6. Sreeram P, McGee J, Gungor A, Arntfield S. Medical management prior to Hysterectomy for benign indications: Trends from tertiary care centre. Clin Obstet Gynaecol Reprod Med. 2019;5:3-5.

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