Emergency peripartum hysterectomy: A prospective study in The Netherlands.
OBJECTIVE
To determine the incidence, indication, association with caesarean section (CS) and outcome of emergency peripartum hysterectomy (EPH) in The Netherlands.


METHODS
All 100 Dutch obstetric departments were asked to participate in a prospective nationwide registration of EPH between 1 April 2002 and 1 April 2003. For every case, a form with questions about obstetrical history, current pregnancy and delivery, maternal and neonatal outcome was completed.


RESULTS
Eighty-nine (89%) hospitals participated and registered in total 48 EPH. The estimated incidence of EPH is 0.33/1000 births. The main indication for EPH was placenta accreta (50%), followed by uterine atony (27%). There were two maternal deaths (4%). Severe maternal morbidity included: urinary tract injury 15%, relaparotomy 25%, transfusion >10 units red blood cells 67%, intensive care admission 77%. Both previous CS and CS in the index pregnancy were associated with a significant increased risk of EPH. The number of previous CS was related to an increased risk of placenta accreta, from 0.19% for one previous CS to 9.1% for four or more previous CS.


CONCLUSIONS
Emergency peripartum hysterectomy is associated with a high incidence of maternal morbidity and a case fatality rate of 4%. It is significantly related to CS in index or previous pregnancy. Placenta accreta is the most common indication to perform a peripartum hysterectomy.
Kwee
Anneke
A
University Medical Centre Utrecht, Location WKZ, Department of Obstetrics and Gynaecology, Kwee, Gynaecologist, Room Number KE 04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands. a.kwee@umcutrecht.nl
Bots
Michiel L
ML
Visser
Gerard H A
GH
Bruinse
Hein W
HW
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D015994:Incidence; D009426:Netherlands / 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; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D014593:Uterine Inertia / Q000453:epidemiology / Q000601:surgery