title: Temporal trends and determinants of peripartum hysterectomy in Lombardy, Northern Italy, 1996-2010.
abstract: OBJECTIVE
  To analyze the temporal trends of peripartum hysterectomy (PH) in the period 1996-2010 in Lombardy, Italy.
  
  
  METHODS
  Using data from the Regional Database, PH ratios/1,000 deliveries were calculated from 1996 to 2010, in strata of age and mode of delivery among women resident in Lombardy, Italy. PH cases were identified searching the database for the ICD-9 and ICD-10 codes for subtotal and total hysterectomy. PH ratios/1,000 deliveries in strata of age, mode of delivery and calendar year were computed. Poisson's regression analysis was used to test trend over time.
  
  
  RESULTS
  A total of 905 PH and 1,289,163 deliveries were recorded between 1996 and 2010. The overall PH ratio was 0.70/1,000 deliveries. The PH ratio/1,000 deliveries increased over time, being 0.57 in 1996 and 0.88/1,000 deliveries in 2010 (P < 0.0001). After including calendar year, mode of delivery and maternal age in the Poisson's regression equation, no significant linear trend emerged in the PH ratio over time (P = 0.28). Women who underwent cesarean section (CS) (CS vs. vaginal delivery: OR 5.66, 95 % CI 4.91-6.54) and older women were at increased risk of PH (maternal age ≥40 vs. <30 years: OR 5.66, 95 % CI 4.48-7.15). The frequency of intractable peripartum hemorrhage and placenta praevia/accreta, the main indications for PH, significantly increased over the study period.
  
  
  CONCLUSIONS
  In Lombardy, the PH ratio increased between 1996 and 2010. In our population, rising frequency of CS and older maternal age may explain this trend.
authors.affiliation: Dipartimento Materno-Infantile, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, via Commenda 12, 20122 Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Parazzini
authors.forename: Elena
authors.initials: E
authors.lastname: Ricci
authors.forename: Sonia
authors.initials: S
authors.lastname: Cipriani
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaffarino
authors.forename: Renata
authors.initials: R
authors.lastname: Bortolus
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bulfoni
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data / Q000639:trends*; D007558:Italy / Q000453:epidemiology; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000601:surgery*; D016017:Odds Ratio; D016012:Poisson Distribution; D011247:Pregnancy; D012044:Regression Analysis; D012307:Risk Factors