Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study.
OBJECTIVE
To provide an estimate of the incidence of peripartum hysterectomy in the state of New Jersey and calculate the effect of mode of delivery and prior obstetric history.


METHODS
A perinatal-linked dataset provided by the Maternal Child Health Epidemiology Program in the New Jersey Department of Health was used to obtain information from birth certificates and hospital discharge records. Using multivariate logistic regression, various demographic and clinical factors were assessed for association with peripartum hysterectomy.


RESULTS
A total of 1,004,116 births were identified between 1997 and 2005 and 853 peripartum hysterectomies were performed (0.85/1,000 deliveries). Parity increased the risk of hysterectomy with nulliparous women having approximately half the risk compared to multiparous women. Cesarean delivery with no previous c-section almost doubled the risk (OR 2.20, CI 1.80-26.69) while in the presence of a previous c-section the risk was almost four times higher (OR 4.51, CI 3.76-5.40). Operative vaginal delivery did not result in any increase in the risk.


CONCLUSIONS
Mode of delivery and prior obstetric history are major risk factors for peripartum hysterectomy. Patients desiring cesarean delivery need to be counseled on the risk of this serious complication.
Spiliopoulos
Michail
M
Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, PA, USA. spilias112@gmail.com
Kareti
Aparna
A
Jain
Neetu J
NJ
Kruse
Lakota K
LK
Hanlon
Alex
A
Dandolu
Vani
V
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D017604:Cesarean Section, Repeat; D003430:Cross-Sectional Studies; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D009515:New Jersey; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000601:surgery; D010298:Parity; D058725:Peripartum Period; D010923:Placenta Previa / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult