Abstract
Objective
The objective was to review all emergency peripartum hysterectomies performed at a tertiary hospital in London, UK, and to identify the risk factors for emergency peripartum hysterectomy.
Method
A retrospective case control study. The cases consisted of all women who had emergency peripartum hysterectomy between 1 January 1993 and 31 December 2003. Controls were women who delivered immediately before and after the indexed case. Demographic data, medical and surgical histories, pregnancy, intrapartum and postpartum data were collected. Differences between cases and controls were compared with χ2, Fisher exact and Student t tests. Multiple logistic regression analysis was performed to identify independent risk factors for emergency peripartum hysterectomy.
Results
There were 15 cases of emergency peripartum hysterectomy in 31,079 deliveries, giving a rate of 0.48 per 1,000. Women who had emergency peripartum hysterectomy were significantly older (mean age 37 years vs. 29 years, P<0.001) and multiparous (P=0.02). More of the cases had a history of uterine surgery (67 vs. 30%, P=0.01), placenta praevia (60 vs. 3%, P<0.0001) and were delivered by caesarean section (86.7 vs. 30%, P=0.003). Eighty percent of the hysterectomies were performed in the daytime and all were done by consultants. Haemorrhage due to placenta praevia was the main indication for emergency peripartum hysterectomy (47%). Independent risk factors for emergency peripartum hysterectomy were older age (odds ratios [OR] 1.2, 95% confidence interval [95% CI] 1.2–1.6), multiparity (OR 2.6, 95% CI 1.3–10.2), history of previous caesarean section (OR 13.5, 95% CI 2.7–65.4), caesarean delivery in index pregnancy (OR 11.6, 95% CI 2.1–68.6) and caesarean delivery in index pregnancy for placenta praevia (OR 18, 95% CI 3.6–69).
Conclusion
Caesarean deliveries, especially repeat caesareans in women with placenta praevia, significantly increase the risk of emergency peripartum hysterectomy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahn JJ (1987) Clinical analysis of caesarean hysterectomy. Korean J Obstet Gynecol 30:651–661
Bai SW, Lee HJ, Cho JS, Park YW, Kim SK, Park KH (2003) Peripartum hysterectomy and associated factors. J Reprod Med 48:148–152
Baker ER, D’Alton ME (1994) Caesarean section birth and caesarean hysterectomy. Clin Obstet Gynaecol 37:806–815
Bakri YN, Amri A, Abdul Jabbar F (2001) Tamponade-balloon for obstetrical bleeding. Int J Gynecol Obstet 74:139–142
Bakshi S, Meyer BA (2000) Indications for and outcomes of emergency peripartum hysterectomy. J Reprod Med 45:733–737
Barclay DL (1970) Caesarean hysterectomy. Obstet Gynecol 35:120–131
Chestnut DH, Eden RD, Gall SA (1985) Peripartum hysterectomy: a review of caesarean and postpartum hysterectomy. Obstet Gynecol 65:365–370
Clark SL, Yeh SY, Phelan JP, Bruce S, Paul RH (1984) Emergency hysterectomy for obstetric haemorrhage. Obstet Gynecol 64:376–380
Clark SL, Koomings PP, Phelan JP (1985) Placenta previa/accreta and previous caesarean section. Obstet Gynecol 66:89–92
Engelsen BE, Albrechtsen S, Iversen OE (2001) Peripartum hysterectomy—incidence and maternal morbidity. Acta Obstet Gynecol Scand 80:409–412
Gardeil F, Daly S, Turner MJ (1995) Peripartum hysterectomy. Report of eleven cases. Rev Fr Gynecol Obstet 90:431–434
Hayashi RH, Castillo MS, Noah ML (1981) Management of severe postpartum haemorrhage due to uterine atony using an analogue of prostaglandin F2α. Obstet Gynecol 58:426
Johanson R, Kumar M, Obhrai M, Young P (2001) Management of massive postpartum haemorrhage: use of a hydrostatic balloon catheter to avoid laparotomy. Br J Obstet Gynaecol 108:420–422
Kastner ES, Figueroa R, Garry D, Maulik D (2002) Emergency peripartum hysterectomy: experience at a community teaching hospital. Obstet Gynecol 99:971–975
Katesmark M, Brown R, Raju KS (1994) Successful use of a Sengstaken-Blakemore tube to control massive postpartum haemorrhage. Br J Obstet Gynaecol 101:259–260
Lynch CB, Coker A, Lawal AH (1997) The B-Lynch surgical technique for control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol 104:372–376
Plauche WC (1988) Peripartum hysterectomy. Obstet Gynecol Clin North Am 15:783–795
Stanco LM, Schrimmer DB, Paul RH, Mishell DR (1993) Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol 168:879–883
Thomas J, Paranjothy S (2001) The National Sentinel Caesarean Section Audit Report. Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. RCOG Press, London
Thonet RGN (1986) Obstetric hysterectomy—an 11 year experience. Br J Obstet Gynaecol 93:270–274
Zamzami TYY (2003) Indication of emergency peripartum hysterectomy: review of 17 cases. Arch Gynecol Obstet 268:131–135
Zelop CM, Harlow BL, Frigoletto FDJ, Safon LE, Saltzman DH (1993) Emergency peripartum hysterectomy. Am J Obstet Gynecol 168:1443–1448
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Selo-Ojeme, D.O., Bhattacharjee, P., Izuwa-Njoku, N.F. et al. Emergency peripartum hysterectomy in a tertiary London hospital. Arch Gynecol Obstet 271, 154–159 (2005). https://doi.org/10.1007/s00404-004-0715-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-004-0715-x