Postpartum hysterectomy.
OBJECTIVE
To review cases of postpartum hysterectomy regarding indications, risk factors and complications and compare them with cases of emergency cesarean section.


METHODS
We conducted a retrospective chart review study of 20 cases of postpartum hysterectomy and 20 cases of emergency cesarean section performed at Sinai Samaritan Medical Center, Milwaukee, Wisconsin, between January 1984 and January 1994. Emergency postpartum hysterectomies were compared with emergency cesarean sections regarding obstetric history, placental location, operative time, blood loss, blood transfusion, intra- and postoperative complications and length of hospitalization. Emergency hysterectomies were reviewed according to their indications for the incidence of complications and length of hospitalization. Pathological diagnoses of the hysterectomy specimens were reviewed. Statistical analyses were performed using the two-tailed Student's t-test and Fisher's exact test.


RESULTS
Placenta accreta was the most common indication for emergency postpartum hysterectomy. Prior cesarean section and/or placenta previa were risk factors. Emergency hysterectomies were associated with longer operating times (P < 0.0001), greater blood loss (P < 0.0001), more transfusions (P < 0.001), postoperative complications (P < 0.01), secondary surgeries (P < 0.01) and longer hospitalizations (P < 0.0001) than cases of emergency cesarean section.


CONCLUSIONS
Emergency postpartum hysterectomy is associated with significant blood loss, need for transfusion, postoperative complications and longer hospitalization partly because of its indications. The combination of prior cesarean section and current placenta previa should alert the obstetrician that an emergency postpartum hysterectomy may be needed.
Department of Obstetrics and Gynecology, University of Wisconsin Medical School, Milwaukee, USA.
G H
GH
Eltabbakh
J D
JD
Watson
D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010921:Placenta Accreta / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors