Risk factors for cesarean hysterectomy in tertiary center in Thailand: a case-control study

To identify the risk factors for cesarean hysterectomy in a tertiary center in Bangkok, Thailand.

A case-control study was conducted by reviewing the medical records of pregnant women delivered at BMA Medical College and Vajira Hospital between 1 January 2001 and 28 February 2007. The case refers to pregnant women who underwent hysterectomy immediately or within 24 h following cesarean delivery. Controls included pregnant women who received cesarean section during the same study period by a ratio of 1:5 (case : control).

During the study period, cesarean hysterectomy complicated 30 deliveries out of 31 106 deliveries (0.96:1000). Independent risk factors for cesarean hysterectomy from a multivariate logistic regression analysis were placental adherence (odds ratio [OR] = 440, 95% confidence interval [CI] 28-7000), placenta previa (OR = 57, 95% CI 6.0-540) and uterine atony (OR = 37, 95% CI 7.5-190). Sixty-three percent (5/8) of placental adherence were associated with placenta previa. Of these five patients, four had a uterine scar from a prior cesarean section. The following outcomes were significantly higher in the cesarean hysterectomy group as compared to the controls: operative time, blood loss, hypovolemia, coagulopathy, transfusions, febrile morbidity, secondary surgery, and duration of hospitalization.

Placental adherence, placenta previa and uterine atony were identified as significant risk factors for cesarean hysterectomy. Cesarean section due to placenta previa should be electively scheduled with well-prepared blood components. The obstetrician should provide counsel and obtain detailed informed consent with regard to the possibility of cesarean hysterectomy.