Obstetric hysterectomy: changing trends over 20 years in a multiethnic high risk population

The aim of this study was to determine the demographics, indication and complications of emergency postpartum hysterectomy in a multiethnic high-risk obstetric population and to assess if there is a change in trend between 1983 and 2003. Eighteen women underwent postpartum hysterectomies in the 20 year period (prevalence 0.028%) and there were two maternal deaths. Overall, 77% of the postpartum hysterectomies were performed for intractable haemorrhage following caesarean section (CS). There is a statistically significant threefold increase (Mann-Whitney test, p=0.007) in the prevalence of emergency postpartum hysterectomies between 1994 and 2003 as compared to the previous 10 years between 1983 and 1993 despite the introduction of new pharmacological agents and conservative surgical techniques. Subtotal abdominal hysterectomy appears to be the procedure of choice in the more recent 10 years (60% of cases between 1994 and 2003 compared to 25% of cases between 1983 and 1993). Previous Caesarean section, advancing maternal age, abnormal placentation (including placenta praevia) appear to be risk factors for postpartum hysterectomy. Women of black African origin appear to be more at risk for hysterectomy compared to women of other ethinicity.