title: Emergency obstetric hysterectomy.
abstract: BACKGROUND
  All cases of obstetric hysterectomies that were performed in our hospital during a seven-year study period were reviewed in order to evaluate the incidence, indications, risk factors, and complications associated with emergency obstetric hysterectomy.
  
  
  METHODS
  Medical records of 45 patients who had undergone emergency hysterectomy were scrutinized and evaluated retrospectively. Maternal age, parity, gestational age, indication for hysterectomy, the type of operation performed, estimated blood loss, amount of blood transfused, complications, and hospitalization period were noted and evaluated. The main outcome measures were the factors associated with obstetric hysterectomy as well as the indications for the procedure.
  
  
  RESULTS
  During the study period there were 32,338 deliveries and 9,601 of them (29.7%) were by cesarean section. In this period, 45 emergency hysterectomies were performed, with an incidence of 1 in 2,526 vaginal deliveries and 1 in 267 cesarean sections. All of them were due to massive postpartum hemorrhage. The most common underlying pathologies was placenta accreta (51.1%) and placenta previa (26.7%). There was no maternal mortality.
  
  
  CONCLUSIONS
  Obstetric hysterectomy is a necessary life-saving procedure. Abnormal placentation is the leading cause of emergency hysterectomy when obstetric practice is characterized by a high cesarean section rate. Therefore, every attempt should be made to reduce the cesarean section rate by performing this procedure only for valid clinical indications.
authors.affiliation: 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, 80 Vas. Sofias Av., Athens, Greece. gdaskalaki@yahoo.com
authors.forename: George
authors.initials: G
authors.lastname: Daskalakis
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Anastasakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papantoniou
authors.forename: Spyros
authors.initials: S
authors.lastname: Mesogitis
authors.forename: Mariana
authors.initials: M
authors.lastname: Theodora
authors.forename: Aris
authors.initials: A
authors.lastname: Antsaklis
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology; D001803:Blood Transfusion; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D010298:Parity; D010921:Placenta Accreta / Q000601:surgery; D010923:Placenta Previa / Q000601:surgery; D011183:Postoperative Complications; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors