Post-partum hysterectomies: revisited

This retrospective case analysis is performed in order to analyze post-partum hysterectomies in St. Mary's Hospital, Manchester during the last thirteen years and to compare it with the published results twenty years ago. We wanted to determine any possible changes in trends as well as to discuss the place of post-partum hysterectomy in modern obstetric practice. The main outcome measurements were incidence, maternal mortality and morbidity, indications and risk factors for post-partum hysterectomy in our hospital today and twenty years ago. Obtained results were compared to the same data and trends world-wide. There has been a fall in the incidence of both, elective and emergency post-partum hysterectomies in St. Mary's Hospital. All together, 28 women underwent post-partum hysterectomy electively or as an emergency in the period between 1985 and 1997. Mortality rate was 1 in 28 cases and morbidity rate was 65% in emergency group and 37.5% in elective group. The most common indication for elective post-partum hysterectomy is cervical intraepithelial neoplasia. The most important risk factor for emergency post-partum hysterectomy is previous cesarean section especially related to placenta accreta. There was no significant changes in trends, maternal mortality and morbidity and indications related to emergency post-partum hysterectomies today and twenty years ago, while the indications for elective cases were changed.