title: Incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy: a 17-year experience from a single institution.
abstract: OBJECTIVE
  To review the incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy (CH) in our institution.
  
  
  METHODS
  Retrospective study of 158 women who had CH at the Detroit Medical Center during a 17 period.
  
  
  RESULTS
  During the study period, 158 of 202,356 deliveries were CH, giving an overall incidence of 0.78 per 1,000 deliveries. Of the 158 cases, 14 were elective while 144 were emergently performed due to complications encountered at cesarean section. Analysis of the eligible 144 cases showed that the commonest risk factors were previous cesarean delivery (76%) and placenta previa (35%). Abnormal placenta adherence was the indication for CH in 50.7%, followed by uterine atony in 34.7% and uterine rupture in 16.7% of the cases. Febrile morbidity (44.4%) and disseminated intravascular coagulopathy (22.9%) were the most common postoperative complications. Most complications occurred in patients with parity greater than two. Compared to the last decade, CH performed more recently were less likely to be complicated by bowel injury or disseminated intravascular coagulopathy.
  
  
  CONCLUSIONS
  Morbidly adherent placenta has replaced uterine atony as the leading indication for emergent CH in our institution. High parity remains a risk factor for complications; however, we recorded a reduction in bowel injury and disseminated intravascular coagulopathy in recent years.
authors.affiliation: Department of Obstetrics and Gynecology, Hutzel Women's Hospital, Wayne State University School of Medicine/Detroit Medical Center, 3980 John R, 7 Brush North, Detroit, MI 48201, USA. aimudia@med.wayne.edu
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Imudia
authors.forename: Awoniyi O
authors.initials: AO
authors.lastname: Awonuga
authors.forename: Tarek
authors.initials: T
authors.lastname: Dbouk
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Cordoba
authors.forename: Michael P
authors.initials: MP
authors.lastname: Diamond
authors.forename: Ray O
authors.initials: RO
authors.lastname: Bahado-Singh
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D015994:Incidence; D010921:Placenta Accreta / Q000601:surgery; D010923:Placenta Previa / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014593:Uterine Inertia / Q000209:etiology / Q000601:surgery; D014597:Uterine Rupture / Q000209:etiology / Q000601:surgery