title: Predicting factors for emergency peripartum hysterectomy in women with placenta previa.
abstract: OBJECTIVE
  The aim of the study was to identify predictive factors for peripartum hysterectomy in women with placenta previa.
  
  
  METHODS
  We retrospectively reviewed all singleton pregnancies with a diagnosis of placenta previa, with the distance between the lower placenta edge and the internal cervical os is ≤2 cm, during the period June 2006-May 2010. Antepartum characteristics of women who did and did not undergo peripartum hysterectomy were compared: they include demographical data, obstetrics history, clinical course of the index pregnancy and sonographic findings.
  
  
  RESULTS
  Two-hundred and forty-seven women were selected. peripartum hysterectomy was required in 12 cases (4.9%). A statistically significant increased risk emerged for a history of cesarean section (p < 0.001), major placenta previa (p < 0.001), sonographic suspect of placenta accreta (p < 0.001) and gestational age at delivery <34 weeks' gestation (p < 0.001). These four variables were entered into an unconditioned logistic regression model. The resulting adjusted ORs were 23.1 (95% CI 2.3-235.3, p = 0.008), 14.6 (95% CI 0.6-346.5, p = 0.097), 42.4 (95% CI 5.1-354.5, p = 0.001) and 9.3 (95% CI 1.1-76.9, p = 0.037), respectively.
  
  
  CONCLUSIONS
  This study confirms that placenta previa is a condition at substantial risk of peripartum hysterectomy. A history of cesarean section, the sonographic suspect of placenta accreta and gestational age at delivery were found to be independently associated with this risk. Antepartum ultrasonography in particular plays a crucial role in predicting hysterectomy in these cases.
authors: Department Obstet-Gynaecol, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Commenda, 12, 20122 Milan, Italy.
authors: Erika
authors: E
authors: Giambattista
authors: Manuela Wally
authors: MW
authors: Ossola
authors: Silvia Francesca
authors: SF
authors: Duiella
authors: Francesca
authors: F
authors: Crovetto
authors: Barbara
authors: B
authors: Acaia
authors: Edgardo
authors: E
authors: Somigliana
authors: Luigi
authors: L
authors: Fedele
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy; D058725:Peripartum Period; D010921:Placenta Accreta / Q000000981:diagnostic imaging; D010923:Placenta Previa / Q000000981:diagnostic imaging / Q000601:surgery*; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery*