Emergency hysterectomy for obstetric hemorrhage.
From 1978 to 1982, 70 cases of emergency hysterectomy for obstetric hemorrhage were performed at Los Angeles County/University of Southern California Women's Hospital. Sixty hysterectomies followed cesarean section, and ten were performed for hemorrhage after vaginal delivery. The most common indication for hysterectomy was atony (43%) followed by placenta accreta (30%), uterine rupture (13%), extension of a low transverse incision (10%), and leiomyomata preventing uterine closure and hemostasis (4%). Hysterectomies performed for atony had a significant association with the following factors when compared to hysterectomies performed for other indications: 1) amnionitis, 2) cesarean section for labor arrest, 3) oxytocin augmentation of labor, 4) MgSO4 infusion, and 5) fetal weight. Fifty-seven percent of hysterectomies performed for placenta accreta were associated with a previous cesarean section. During the study period, 53% of all patients presenting at term with both a placenta previa and one or more previous cesarean sections, subsequently underwent hysterectomy for placenta accreta. Even with a broad inclusion of risk factors, only 74% of patients developing a hemorrhagic complication leading to hysterectomy can be identified before delivery.
D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007744:Obstetric Labor Complications / Q000601:surgery; D010921:Placenta Accreta / Q000601:surgery; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000601:surgery*; D014593:Uterine Inertia / Q000601:surgery