title: Emergency peripartum hysterectomy in a tertiary hospital in Ankara, Turkey: a 5-year review.
abstract: OBJECTIVE
  To determine the incidence, indications and the risk factors of emergency peripartum hysterectomy (EPH).
  
  
  METHODS
  We analyzed retrospectively 30 cases of emergency peripartum hysterectomy performed at the Obstetrics Department of a tertiary, research and education hospital between the years of 2006 and 2010. Demographic, medical and clinical data of the patients were recorded. Data stored were expressed as mean ± standard deviation.
  
  
  RESULTS
  There were 30 cases of EPH among 82,363 deliveries. The overall incidence of EPH was 0.364 per 1,000 deliveries from 2006 to 2010. Nine hysterectomies were performed after vaginal delivery (0.16/1,000 vaginal deliveries) and the remaining 21 hysterectomies were performed after cesarean section (0.78/1,000 cesarean sections). Two cases (6.7 %) were performed as subtotal and remaining 28 cases (93.3 %) were performed as total hysterectomy. Indications of EPH were uterine atony (43.3 %, 13/30), placenta accreta (40.0 %, 12/30) and uterine rupture (16.7 %, 5/30). All patients [7/7 (100 %)] with placenta previa and 11 of 12 patients (91.7 %) with placenta accreta had previously cesarean sections. There were two maternal deaths due to coagulopathy and pulmonary embolism. Two stillbirths (6.6 %) and 2 early neonatal deaths (6.6 %) were recorded.
  
  
  CONCLUSIONS
  It should be kept in mind that cases of placenta previa and/or placenta accreta with previous cesarean sections have a very high probability of EPH. The delivery should be performed in suitable clinical settings with experienced surgeons when the risk factors like placenta previa and/or placenta accreta are determined so as to achieve optimal outcome.
authors: Ministry of Health, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
authors: Omer Lutfi
authors: OL
authors: Tapisiz
authors: Sadiman Kiykac
authors: SK
authors: Altinbas
authors: Bulent
authors: B
authors: Yirci
authors: Pinar
authors: P
authors: Cenksoy
authors: Aski Ellibes
authors: AE
authors: Kaya
authors: Suat
authors: S
authors: Dede
authors: Omer
authors: O
authors: Kandemir
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000401:mortality / Q000601:surgery*; D058725:Peripartum Period; D010921:Placenta Accreta / Q000601:surgery; D010923:Placenta Previa / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth; D014421:Turkey / Q000453:epidemiology; D014593:Uterine Inertia / Q000601:surgery; D014597:Uterine Rupture / Q000601:surgery; D055815:Young Adult