title: Emergency peripartum hysterectomy: a comparison of cesarean and postpartum hysterectomy.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the incidence, risk factors, indications, outcomes, and complications of emergency hysterectomy performed after cesarean deliveries (cesarean hysterectomy) and vaginal deliveries (postpartum hysterectomy).
  
  
  METHODS
  We conducted a retrospective cohort study from 1990 to 2002 of patients who had peripartum hysterectomies at a single tertiary hospital. Comparisons were made between cesarean and postpartum hysterectomies.
  
  
  RESULTS
  There were 55 cases of emergency peripartum hysterectomy (38 cesarean hysterectomies, and 17 postpartum hysterectomies), for a rate of 0.8 per 1000 deliveries. Overall, the most common indication for hysterectomy was uterine atony (56.4%), followed by placenta accreta (20.0%). Average estimated blood loss was 3325.6+/-1839.2 mL, average operating time was 157.1+/-75.4 minutes, average time from delivery to completing the hysterectomy was 333.8+/-275.7 minutes, and the average length of hospitalization was 11.0+/-7.9 days. The cesarean delivery rate at Grady Memorial Hospital during the study period was 14.2%. There were no statistically significant differences between variables examined when comparisons were made by cesarean vs postpartum hysterectomy.
  
  
  CONCLUSIONS
  Uterine atony is the leading indication for emergency hysterectomy performed following cesarean and vaginal deliveries.
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA. fforna@emory.edu
authors.forename: Fatu
authors.initials: F
authors.lastname: Forna
authors.forename: Annette M
authors.initials: AM
authors.lastname: Miles
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000328:Adult; D000367:Age Factors; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007743:Labor, Obstetric; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000601:surgery*; D049590:Postpartum Period; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011336:Probability; D018570:Risk Assessment; D016896:Treatment Outcome; D014593:Uterine Inertia / Q000601:surgery*