Safety and clinical outcomes of obstetric hysterectomies in patients treated at a tertiary hospital in Chile

Objective: To describe the incidence, clinical characteristics, and complications of obstetric hysterectomy in a tertiary hospital in Chile from 2021 to 2023. Methods: Retrospective descriptive cohort study including all women with a gestational age ≥20 weeks or up to six weeks postpartum who underwent obstetric hysterectomy at Santiago Oriente Dr. Luis Tisné Brousse Hospital. Clinical and surgical data were collected from institutional records. Descriptive statistics were performed. Results: Twenty-five obstetric hysterectomies were performed during the study period. Incidence per 1,000 live births decreased from 3.22 in 2021 to 1.81 in 2023. Postpartum hemorrhage was the main indication (52%), followed by placenta accreta spectrum (32%), infection (12%), and uterine rupture (4%). Supracervical hysterectomy was performed in 52% of cases, and total hysterectomy in 48%; 68% were emergencies. One intraoperative complication (bladder injury) was reported. Postoperative complications occurred in 84% of cases, the most frequent being anemia (84%) and hemorrhagic shock (36%). No significant associations were found between baseline characteristics and complications. Conclusion: Although its incidence is declining, obstetric hysterectomy remains associated with high morbidity. Strengthening prevention, early detection, and timely multidisciplinary care is essential. Further prospective, multicenter studies are needed to inform strategies to improve maternal outcomes.