Incidence and Determinants of Peripartum Hysterectomy

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 01/2007; 108(6):1486-92. DOI: 10.1097/01.AOG.0000245445.36116.c6
Source: PubMed


Most studies of peripartum hysterectomy are conducted in single institutions, limiting the ability to provide national incidence estimates and examine risk factors. The objective of this study was to provide a national estimate of the incidence of peripartum hysterectomy and to examine factors associated with the procedure.
We used data for 1998-2003 from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationally representative survey of inpatient hospitalizations. Peripartum hysterectomy was defined as a hysterectomy and delivery occurring during the same hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for maternal and hospital characteristics using logistic regression.
During 1998-2003, an estimated 18,339 peripartum hysterectomies occurred in the United States (0.77 per 1,000 deliveries). Compared with vaginal delivery without a previous cesarean delivery, the ORs of peripartum hysterectomy for other delivery types were as follows: repeat cesarean, 8.90 (95% CI 8.09-9.79); primary cesarean, 6.54 (95% CI 5.95-7.18); and vaginal birth after cesarean, 2.70 (95% CI 2.23-3.26). Multiple births were associated with an increased risk compared with singleton births (OR 1.41, 95% CI 1.16-1.71).
Our results suggest that vaginal birth after cesarean, primary and repeat cesarean deliveries, and multiple births are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern, given the increasing rate of both cesarean deliveries and multiple births in the United States.

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    • "Emergency peripartum hysterectomy is a life-saving surgical procedure, which is performed to control massive hemorrhage. The incidence rate has estimated about 1.5 per 1,000 deliveries in developed countries.[123] Cesarean delivery is the major risk factor for peripartum hysterectomy and due to recently raising cesarean delivery rate and the increasing population with a scarred uterus, the incidence of emergency peripartum hysterectomy may indirectly increase. "
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    ABSTRACT: Peripartum hysterectomy is associated with significant morbidity and mortality. We determined the factors leading to and maternal mortality and morbidity rates among the women whose underwent peripartum hysterectomy in Iran. This case-series study was conducted from March 2004 to March 2009 in the Department of Gynecology and Obstetrics at two central university hospitals (Azahra hospital and Shahid Beheshti Hospital) in Isfahan. Forty one women among 29,444 deliveries underwent peripartum hysterectomy. Women who had delivery before 24 weeks and a hysterectomy for other reasons like sterilizations were excluded. Incidence, indications and maternal complications including maternal death and urological, infectious and wound complications were evaluated after operation. During the study period, the incidence of peripartum hysterectomy estimated about 1.39 per 1,000 deliveries. The maternal mortality rate was 17.07%. There was no statistical difference in mortality rates between referrals and non-referrals women (P = 0.6). Post-operative complications included infection (22%), bladder injuries (7.3%), urine retention (4.8%) and wound dehiscence (4.87%). The main indication was placenta accreta 28 (68.3%). This study indicated the high rate of mortality among patients underwent peripartum hysterectomy. Evaluation of management during referring the patients and designing more studies to evaluate the mortality and morbidities are warranted.
    03/2013; 2:20. DOI:10.4103/2277-9175.108004
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    ABSTRACT: Ginecol Obstet Mex 2012;80(2):79-83 Artículo original RESUMEN El acretismo placentario es la segunda causa de hemorragia obstétrica en el mundo que casi siempre requiere histerectomía obstétrica de urgencia, lo que incrementa la morbilidad y mortalidad materna. Se comunica una alternativa quirúrgica a la histerectomía obstétrica que ha permitido reducir, hasta el momento, a cero nuestra tasa de muertes maternas por hemorragia obstétrica, disminuir el tiempo de la cirugía y la morbilidad asociada, sin modificar los resultados perinatales. Palabras clave: acretismo placentario, hemorragia obstétrica, histerectomía obstétrica. ABSTRACT The placenta accreta is the second leading cause of obstetric hemorrhage, which often require the implementation of emergency obstetric hysterectomy increased morbidity and mortality. We present a surgical alternative to hysterectomy obstetric allowed us to reduce to zero until our rate of maternal deaths from obstetric hemorrhage. Improving surgical times, associated morbidity, without altering perinatal outcomes.
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    ABSTRACT: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery. Peripartum hysterectomy was defined as a hysterectomy after birth until 1 month after delivery using the codes for hysterectomy from the NOMESCO classification (1995). National data from the period 1995-2004 were extracted from the Danish Medical Birth Register and linked to the Danish National Hospital Register followed by registration of relevant data from the medical records of all the patients. We found 152 hysterectomies corresponding to an incidence of 0.24/1,000 deliveries. The risk of peripartum hysterectomy increased 11-fold following caesarean compared to vaginal delivery. Placenta accrete was present in 37% of the cases and 68%. Peripartum hysterectomy has increased significantly during the last 20 years. Optimizing treatment of PPH may decrease the incidence of peripartum hysterectomy in the future.
    Acta Obstetricia Et Gynecologica Scandinavica 02/2007; 86(12):1472-5. DOI:10.1080/00016340701692651 · 2.43 Impact Factor
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