Peripartum hysterectomy and cesarean delivery: a population-based study.
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.
Stivanello
Elisa
E
Department of Medicine and Public Health, University of Bologna, Bologna, Italy.
Knight
Marian
M
Dallolio
Laura
L
Frammartino
Brunella
B
Rizzo
Nicola
N
Fantini
Maria Pia
MP
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