title: Peripartum hysterectomy and cesarean delivery: a population-based study.
abstract: OBJECTIVE
  To estimate the incidence of peripartum hysterectomy in an Italian Region (Emilia-Romagna) and investigate its association with cesarean delivery.
  
  
  METHODS
  Population-based retrospective study using hospital discharge records.
  
  
  METHODS
  All public and private hospitals in Emilia-Romagna region, Italy.
  
  
  METHODS
  A total of 151,494 women delivering between 2003 and 2006, 131 of whom had a peripartum hysterectomy.
  
  
  METHODS
  Peripartum hysterectomy was defined as a hysterectomy performed at the time of delivery or afterwards during the same hospitalization. Incidence rates were calculated by type of delivery. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated with logistic regression to evaluate the association between peripartum hysterectomy and delivery type.
  
  
  METHODS
  Incidence rates of peripartum hysterectomy by type of delivery; odds of peripartum hysterectomy after primary or repeat cesarean compared with vaginal delivery without previous cesarean.
  
  
  RESULTS
  A total of 131 peripartum hysterectomies were performed among 151,494 deliveries (0.86/1,000 deliveries; 95% CI 0.72-1.03) with 20.7% primary and 9.6% repeat cesarean deliveries. Women undergoing a primary caesarean delivery were more likely to have a peripartum hysterectomy than women having a vaginal delivery who had never had a cesarean delivery (OR 6.48; 95% CI 4.16-10.07). Women undergoing a repeat caesarean delivery were also at increased risk (OR 3.69; 95% CI 2.11-6.46).
  
  
  CONCLUSIONS
  In this population, primary and repeat cesarean deliveries are associated with an increased risk of peripartum hysterectomy. These results are of particular concern given the steady increase in the cesarean delivery rate in many countries. The pathological mechanism of this association requires further investigation.
authors.affiliation: Department of Medicine and Public Health, University of Bologna, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Stivanello
authors.forename: Marian
authors.initials: M
authors.lastname: Knight
authors.forename: Laura
authors.initials: L
authors.lastname: Dallolio
authors.forename: Brunella
authors.initials: B
authors.lastname: Frammartino
authors.forename: Nicola
authors.initials: N
authors.lastname: Rizzo
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Fantini
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D011247:Pregnancy; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors