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Emergency peripartum hysterectomy

C M Zelop¹, B L Harlow, F D Frigoletto

¹Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.

American Journal of Obstetrics and Gynecology

|May 1, 1993

Summary

Emergency peripartum hysterectomy incidence rises with parity, particularly with placenta previa or prior C-section. Abnormal adherent placentation is the leading cause, with high maternal morbidity despite no deaths.

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Area of Science:

Obstetrics and Gynecology
Surgical Procedures
Maternal Health

Background:

Emergency peripartum hysterectomy is a critical obstetric procedure.
Understanding its indications and incidence is vital for improving maternal outcomes.

Purpose of the Study:

To evaluate the clinical indications and incidence of emergency peripartum hysterectomy.
To analyze these factors in relation to demographic characteristics and reproductive history.

Main Methods:

Retrospective analysis of hospital-based obstetric records over a 9-year period.
Identification of all emergency peripartum hysterectomy cases.
Calculation of incidence rates and statistical trend analysis.

Main Results:

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Overall incidence was 1.55 per 1000 deliveries.
Incidence significantly increased with parity, placenta previa, and prior cesarean section.
Abnormal adherent placentation (64%) and uterine atony (21%) were primary causes.
High maternal morbidity (50% infection, 87% transfusion) was observed.

Conclusions:

Abnormal adherent placentation is the main indication for emergency peripartum hysterectomy.
Increasing parity, placenta previa, and prior C-section elevate hysterectomy risk.
Despite no maternal deaths, significant maternal morbidity persists.