Risk factors for cesarean hysterectomy in cesarean delivery

To identify the risk factors for cesarean hysterectomy.

A case-control study was conducted by reviewing the medical records of pregnant women delivered in King Chulalongkorn Memorial Hospital between January 1994 and December 2004. Cases included pregnant women who underwent hysterectomy immediately or within 24 hours after cesarean delivery, whereas control referred to pregnant women who underwent cesarean section at the same period.

Of the 109,005 deliveries, twenty-seven women (0.25/1000-delivery) underwent cesarean hysterectomy. With multivariate analysis, the risk factors significantly associated with peripartum hysterectomy were placenta previa (adjusted OR = 67.96, 95% CI = 15.32, 301.46) and multiparity (adjusted OR = 7.30, 95% CI = 1.24, 43.19). When compared to controls, cases with cesarean hysterectomy had higher incidence of maternal and neonatal morbidities, needed more blood transfusion and required longer hospital stays. Operation performed in daytime found to have less mean blood loss (1,766 ml) compared to operation at nighttime (5,730 ml).

Placenta previa and multiparity were significant risk factors of cesarean hysterectomy. Cesarean section in these cases should be done by experienced obstetricians with good preoperative care and if possible, during the daytime. Before an operation, each patient and her family should be counseled and informed regarding the risk for complications included hysterectomy.