Identifying risk factors for peripartum cesarean hysterectomy: A population-based study

Eyal Sheiner, Amalia Levy, Miriam Katz, Moshe Mazor

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

OBJECTIVE: To determine the incidence of, and obstetric risk factors for, emergency peripartum hysterectomy. STUDY DESIGN: A population-based study comparing all singleton deliveries between the years 1988 and 1999 that were complicated with peripartum hysterectomy to deliveries without this complication. Statistical analysis was performed with multiple logistic regression analysis. RESULTS: Emergency peripartum hysterectomy complicated 0.048% (n = 56) of deliveries in the study (n = 117,685). Independent risk factors for emergency peripartum hysterectomy from a backward, stepwise, multivariable logistic regression model were: uterine rupture (OR = 521.4, 95% CI 197.1-1379.7), placenta previa (OR = 8.2, 95% CI 2.2-31.0), postpartum hemorrhage (OR = 33.3, 95% CI 12.6-88.1), cervical tears (OR = 18.0, 95% CI 6.2-52.4), placenta accreta (OR = 13.2, 95% CI 3.5-50.0), second-trimester bleeding (OR= 9.5, 95% CI 2.3-40.1), previous cesarean section (OR = 6.9, 95% CI 3.7-12.8) and grand multiparity (>5 deliveries) (OR = 3.4, 95% CI 1.8-6.3). Newborns delivered after peripartum hysterectomy had lower Apgar scores (< 7) at 1 and 5 minutes than did others (OR = 11.5, 95% CI 6.2-20.9 and OR = 27.4, 95% CI 11.2-67.4, respectively). In addition, higher rates of perinatal mortality were noted in the uterine hysterectomy vs. the comparison group (OR = 15.9, 95% CI 7.5-32.6). Affected women were more likely than the controls to receive packed-cell transfusions (OR = 457.7, 95% CI 199.2-1105.8) and had lower hemoglobin levels at discharge from the hospital (9.9 ± 1. 3 vs. 12.8 ± 5.7, P < .001). CONCLUSION: Cesarean deliveries in patients with suspected placenta accreta, specifically those performed due to placenta previa in women with a previous uterine scar, should involve specially trained obstetricians. In addition, detailed informed consent about the possibility of emergency peripartum hysterectomy and its associated morbidity should be obtained.

Original languageEnglish
Pages (from-to)622-626
Number of pages5
JournalThe Journal of reproductive medicine
Volume48
Issue number8
StatePublished - 1 Aug 2003

Keywords

  • Cesarean section
  • Emergency treatment
  • Hysterectomy

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Fingerprint

Dive into the research topics of 'Identifying risk factors for peripartum cesarean hysterectomy: A population-based study'. Together they form a unique fingerprint.

Cite this