title: Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study.
abstract: OBJECTIVE
  To evaluate whether cesarean delivery is a risk factor for emergent postpartum hysterectomy.
  
  
  METHODS
  We performed a case-control study of patients who delivered at Women & Infants Hospital between January 1989 and February 2000. Fifty cases of emergent postpartum hysterectomy performed within 14 days of delivery met our inclusion criteria. Using a computer-generated list, two patients admitted to the labor department at a time point similar to that of each case patient were selected as controls (n = 100). We reviewed medical records for demographic data, route of delivery, labor characteristics, surgical history, and indication for hysterectomy. Cases and controls were compared, and logistic regression was used to calculate the odds ratio (OR) and the 95% confidence interval (CI) for the association of delivery route and emergent hysterectomy.
  
  
  RESULTS
  Cesarean delivery was associated with a 13-fold increased risk of emergent hysterectomy when we controlled for previous cesarean delivery, dilation and curettage or abortion before the index pregnancy, use of prostaglandin, and use of pitocin (OR 12.9; 95% CI 5.2, 32.3).
  
  
  CONCLUSIONS
  Cesarean delivery is a significant risk factor for postpartum hysterectomy.
authors.affiliation: Women & Infants Hospital, Providence, Rhode Island 02905, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kacmar
authors.forename: Lisa
authors.initials: L
authors.lastname: Bhimani
authors.forename: Mary
authors.initials: M
authors.lastname: Boyd
authors.forename: Reza
authors.initials: R
authors.lastname: Shah-Hosseini
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peipert
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000706:statistics & numerical data; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000601:surgery*; D016017:Odds Ratio; D049590:Postpartum Period; D011247:Pregnancy; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome