title: Obstetrical Hysterectomy, cesarean delivery and abnormal placentation.
abstract: OBJECTIVE
  To examine the incidence, risk factors, and complications associated with Obstetrical Hysterectomy at a single University Hospital.
  
  
  METHODS
  This was a retrospective study of all cases of Obstetrical Hysterectomy performed between January 1993 and December 2005 at Temple University Hospital, Philadelphia, Pennsylvania. The current procedural terminology (CPT) codes were used to identify patients, and chart review was used to collect demographics and indications.
  
  
  RESULTS
  During the study years, 19 patients underwent Obsterical Hysterectomy. Of these, 14 (73.7%) had cesarean during their current delivery. Further, 9 (47.4%) of the 19 had previous cesarean deliveries (CDs), with 5 (56%) of the 9 having had two or more previous CDs. Only two women (10.5%) never had cesarean either in the current or previous pregnancy. Eighteen of the women had singleton pregnancies, while only one woman had a twin gestation. A total of 42.1% of the cases had abnormal placentation with 21% experiencing placenta accreta, 15.8% with placenta previa, and 5.3% with placental abruption. A variety of complications arose including fever (52.6%) and blood transfusion (84.2%).
  
  
  CONCLUSIONS
  CD in the current pregnancy and history of CD were strong risk factors for Obstetrical Hysterectomy. There was also a high occurrence of Obstetrical Hysterectomy in patients who had abnormal placentation. This information should be used to counsel women regarding the increased risk of remote complications of CD while discussing the route of delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, PA, USA. vani.dandolu@temple.edu
authors.forename: Vani
authors.initials: V
authors.lastname: Dandolu
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Graul
authors.forename: Amy
authors.initials: A
authors.lastname: Lyons
authors.forename: Diana
authors.initials: D
authors.lastname: Matteo
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D010921:Placenta Accreta / Q000453:epidemiology; D010922:Placenta Diseases / Q000453:epidemiology* / Q000503:physiopathology* / Q000601:surgery; D010923:Placenta Previa / Q000453:epidemiology; D010929:Placentation; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies