• J. Obstet. Gynaecol. Res. · Aug 2011

    Emergency peripartum hysterectomy in a tertiary obstetric center: nine years evaluation.

    • Oya Demirci, Ahmet S Tuğrul, Ertuğrul Yilmaz, Özgür Tosun, Elif Demirci, and Yadigar S Eren.
    • Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey. demircioya@gmail.com
    • J. Obstet. Gynaecol. Res. 2011 Aug 1;37(8):1054-60.

    AimsThe aim of this study was to estimate the incidence, indications, risk factors, complications, and maternal morbidity and mortality associated with obstetric hysterectomy performed at the Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital between January 2000 and January 2008.Material & MethodsA retrospective study of patients requiring an emergency peripartum hysterectomy (EPH) over a 9-year period was conducted. Emergent peripartum hysterectomy was defined as an operation performed in cases whose bleeding was not prevented by other approaches for 24 h after delivery. Thirty-nine cases of emergency peripartum hysterectomy were performed.ResultsThe incidence of emergency peripartum hysterectomy was 0.37 per 1000 deliveries. Thirty-four cases of hysterectomy were performed after cesarean section (CS). The main indication for EPH was placenta accreta (53.8%), followed by uterine atony (25.6%). There were six maternal deaths (15.4%). Severe maternal morbidity included: bladder injury (15.4%), relaparotomy (35.4%), and transfusion >10 unit's red blood cells (15.6%). Both previous CS and CS in the index pregnancy were associated with a significant increased risk of EPH. The number of previous CS was related to an increased risk of placenta accreta; the relative ratio increased from 3.6 for one previous CS to 37 for three or more previous CS.ConclusionEmergency peripartum hysterectomy is significantly related to CS in index or previous pregnancy. Placenta accreta is the most common indication to perform peripartum hysterectomy. EPH is associated with a high incidence of maternal morbidity and mortality.© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

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