title: Is peripartum hysterectomy more common in multiple gestations?
abstract: OBJECTIVE
  To compare the occurrence of peripartum hysterectomy between singleton and multiple gestations.
  
  
  METHODS
  This was a historical cohort study comparing the occurrence of peripartum hysterectomy between singleton and multiple gestations at Banner Good Samaritan Regional Medical Center, Phoenix, Arizona, from January 1, 1996, to December 31, 2001.
  
  
  RESULTS
  During the study years, 42,595 singleton, 1,131 twin, 164 triplet, 35 quadruplet, and 2 quintuplet deliveries occurred. A total of 100 peripartum hysterectomies were performed. Of these hysterectomies, 88 occurred in singletons, 5 in twins, 6 in triplets, and 1 in quadruplets. The overall occurrence of peripartum hysterectomy was 2.28 per 1,000, and the occurrence of emergent peripartum hysterectomy was 1.73 per 1,000. Multiple gestations had a significantly greater risk of emergent peripartum hysterectomy than singletons (odds ratio [OR] 6.04, 95% confidence interval [CI] 3.28-11.11; P < .001). This difference was more pronounced among higher-order multiple gestations: twins (OR 2.95, 95% CI 1.22-7.13, P = .03), triplets (OR 25.22, 95% CI 11.02-57.77, P < .001), and quadruplets (OR 19.53, 95% CI 3.34-114.69, P = .04). When compared with singletons, higher-order multiple gestations had nearly a 24-fold increased risk of emergent peripartum hysterectomy (OR 23.97, 95% CI 11.05-51.99, P < .001).
  
  
  CONCLUSIONS
  Multiple gestations have a significantly higher occurrence of emergent peripartum hysterectomy than singletons. This information should be used in counseling and managing patients with these pregnancies.
authors.affiliation: Phoenix Perinatal Associates and Banner Good Samaritan Regional Medical Center, Scottsdale, Arizona 85255, USA. karrie_francois@obstetrix.com
authors.forename: Karrie
authors.initials: K
authors.lastname: Francois
authors.forename: Joseph
authors.initials: J
authors.lastname: Ortiz
authors.forename: Cathleen
authors.initials: C
authors.lastname: Harris
authors.forename: Michael R
authors.initials: MR
authors.lastname: Foley
authors.forename: John P
authors.initials: JP
authors.lastname: Elliott
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000601:surgery; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011783:Quadruplets; D011811:Quintuplets; D014310:Triplets; D014427:Twins