title: The frequency and complication rates of hysterectomy accompanying cesarean delivery.
abstract: OBJECTIVE
  To estimate the frequency, indications, and complications of cesarean hysterectomy.
  
  
  METHODS
  This was a prospective, 2-year observational study at 13 academic medical centers conducted between January 1, 1999, and December 31, 2000, on all women who underwent a hysterectomy at the time of cesarean delivery. Data were abstracted from the medical record by study nurses. The outcomes included procedure frequency, indications, and complications.
  
  
  RESULTS
  A total of 186 cesarean hysterectomies (0.5%) were performed from a cohort of 39,244 women who underwent cesarean delivery. The leading indications for hysterectomy were placenta accreta (38%) and uterine atony (34%). Of the hysterectomy cases with a diagnosis recorded as accreta, 18% accompanied a primary cesarean delivery, and 82% had a prior procedure (P<.001). Of the hysterectomy cases with atony recorded as a diagnosis, 59% complicated primary cesarean delivery, whereas 41% had a prior cesarean (P<.001). Major maternal complications of cesarean hysterectomy included transfusion of red blood cells (84%) and other blood products (34%), fever (11%), subsequent laparotomy (4%), ureteral injury (3%), and death (1.6%). Accreta hysterectomy cases were more likely than atony hysterectomy cases to require ureteral stents (14% compared with 3%, P=.03) and to instill sterile milk into the bladder (23% compared with 8%, P=.02).
  
  
  CONCLUSIONS
  The rate of cesarean hysterectomy has declined modestly in the past decade. Despite the use of effective therapies and procedures to control hemorrhage at cesarean delivery, a small proportion of women continue to require hysterectomy to control hemorrhage from both uterine atony and placenta accreta.
  
  
  METHODS
  II.
authors.affiliation: From the Departments of Obstetrics and Gynecology at the Ohio State University, Columbus, Ohio; the George Washington University Biostatistics Center, Washington, DC; University of Utah, Salt Lake City, Utah; University of Texas Southwestern Medical Center, Dallas, Texas; University of Alabama at Birmingham, Birmingham, Alabama; University of Pittsburgh, Pittsburgh, Pennsylvania; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; University of Cincinnati, Cincinnati, Ohio; University of Miami, Miami, Florida; University of Tennessee, Memphis, Tennessee; University of Texas at San Antonio, San Antonio, Texas; and Vanderbilt University, Nashville, Tennessee.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Shellhaas
authors.forename: Sharon
authors.initials: S
authors.lastname: Gilbert
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: John C
authors.initials: JC
authors.lastname: Hauth
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
authors.forename: Steven G
authors.initials: SG
authors.lastname: Gabbe
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010921:Placenta Accreta / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D014593:Uterine Inertia / Q000601:surgery; D014599:Uterus / Q000293:injuries