title: Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands.
abstract: OBJECTIVE
  The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage.
  
  
  METHODS
  This was a 2-year prospective nationwide population-based cohort study. All pregnant women in the Netherlands during the same period acted as reference cohort (n = 371,021).
  
  
  RESULTS
  We included 205 women; the overall incidence was 5.7 per 10,000 deliveries. Arterial embolization was performed in 114 women (incidence, 3.2 per 10,000; case fatality rate, 2.0%). Peripartum hysterectomy was performed in 108 women (incidence, 3.0 per 10,000; case fatality rate, 1.9%). Seventeen women underwent hysterectomy after failure of embolization. Cesarean delivery (relative risk, 6.6; 95% confidence interval, 5.0-8.7) and multiple pregnancy (relative risk, 6.6; 95% confidence interval, 4.2-10.4) were the most important risk factors in univariable analysis.
  
  
  CONCLUSIONS
  The rate of obstetric hemorrhage that necessitates hysterectomy or arterial embolization in the Netherlands is 5.7 per 10,000 deliveries; fertility is preserved in 46% of women by successful arterial embolization.
authors.affiliation: Department of Obstetrics, K6-P-35, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. j.j.zwart@lumc.nl
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Zwart
authors.forename: Pieter D
authors.initials: PD
authors.lastname: Dijk
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D008423:Maternal Age; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000628:therapy*