title: Incidence and determinants of peripartum hysterectomy in the metropolitan area of the District of Columbia.
abstract: OBJECTIVE
  To review the impact of the changes that have occurred in the standard of care in obstetrics and in the trend of cesarean delivery rates in recent times and factors associated with peripartum hysterectomy procedure.
  
  
  METHODS
  A retrospective analysis of all cases of peripartum hysterectomies among inpatient hospitalizations at 4 major hospitals in the Washington metropolitan areas of the District of Columbia from January 1, 2000, through December 31, 2009, was conducted.
  
  
  RESULTS
  The total number of deliveries and postpartum hysterectomies that occurred at all 4 locations was 150,847 and 128, respectively. The rate of peripartum hysterectomies per 1,000 deliveries was 0.85. Primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity have direct association with peripartum hysterectomy. Up to 80% of all cases of peripartum hysterectomy are accounted for by class III and IV hemorrhage. Peripartum hysterectomy is associated with increased prevalence of uterine atony, placenta previa, and placenta accreta.
  
  
  CONCLUSIONS
  Our results suggest that primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity, uterine atony, placenta previa, and placental accreta, and class III and IV hemorrhage are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern given the increasing rate of cesarean deliveries in the District.
authors.affiliation: Department of Obstetrics and Gynecology, Howard University Hospital, and the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC, USA. omsanmi@yahoo.com
authors.forename: Michael S
authors.initials: MS
authors.lastname: Owolabi
authors.forename: Richard E
authors.initials: RE
authors.lastname: Blake
authors.forename: Mejebi T
authors.initials: MT
authors.lastname: Mayor
authors.forename: Henry A
authors.initials: HA
authors.lastname: Adegbulugbe
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data / Q000639:trends; D004219:District of Columbia; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data* / Q000639:trends; D008396:Maryland; D008423:Maternal Age; D009765:Obesity / Q000150:complications / Q000601:surgery; D058725:Peripartum Period; D010921:Placenta Accreta / Q000601:surgery; D010923:Placenta Previa / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D019037:Urban Health Services / Q000706:statistics & numerical data; D014593:Uterine Inertia / Q000601:surgery; D055815:Young Adult