Emergency peripartum hysterectomy: experience at a community teaching hospital.
OBJECTIVE
To estimate the incidence, indications, risk factors, and complications associated with emergency peripartum hysterectomy at a community-based academic medical center.


METHODS
We analyzed retrospectively 47 of 48 cases of emergency peripartum hysterectomy performed at Winthrop-University Hospital from 1991 to 1997. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 hours after delivery. Fisher exact test, Wilcoxon rank sum test, and Cochran-Armitage exact trend test were used for analysis.


RESULTS
There were 48 emergency peripartum hysterectomies among 34,241 deliveries for a rate of 1.4 per 1000. Most frequent indications were placenta accreta (48.9%, 12 with previa, 11 without previa), uterine atony (29.8%), previa without accreta (8.5%), and uterine laceration (4.3%). Placenta accreta was the most common indication in multiparous women (58.8%, 20 of 34), uterine atony the most common in primiparas (69.2%, nine of 13). Twenty-two of 23 (95.6%) women with placenta accreta had a previous cesarean delivery or curettage. The number of cesarean deliveries or curettages increased the risk of placenta accreta proportionally. Thirty-eight (80.9%) of the hysterectomies were subtotal. Postoperative febrile morbidity was 34%; other morbidity was 26.3%.


CONCLUSIONS
Placenta accreta has become the most common indication for emergency peripartum hysterectomy.
Kastner
Elana S
ES
Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, New York 11501, USA.
Figueroa
Reinaldo
R
Garry
David
D
Maulik
Dev
D
D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D009518:New York / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000601:surgery; D010921:Placenta Accreta / Q000453:epidemiology / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors