title: Risk factors associated with emergency peripartum hysterectomy.
abstract: BACKGROUND
  Use of an emergency peripartum hysterectomy (EPH) as a lifesaving measure to manage intractable postpartum hemorrhage (PPH) appears to be increasing recently around the world, and the indications for EPH have changed. The object of this study is to identify risk factors associated with EPH.
  
  
  METHODS
  We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1, 2005 and June 30, 2013, at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University, School of Medicine (IPMCH). The parametric t-test, chi-square tests and Logistic regression models were used for analysis to identify the risk factors. The results were considered statistically significant when P < 0.05.
  
  
  RESULTS
  There were 89 178 deliveries during the study period. Twenty-one women had an EPH, with an incidence of 24 per 100 000 deliveries. The loss of blood during postpartum hemorrhage of the EPH group was (5 060.7 ± 3 032.6) ml, and that of the control group was (2 040.8 ± 723.5) ml. There was a significant difference of PHH between the EHP group and the control group (P = 0.001). Independent risk factors for EPH from a logistic regression model were: disseminated intravascular coagulation (DIC) (OR: 9.9, 95% CI 2.8-34, P = 0.003), previous cesarean section (OR: 5.27; 95% CI: 1.48-17.9, P = 0.009), placenta previa (OR: 6.9; 95% CI 1.6-2.9, P = 0.008), the loss of PPH (OR: 1.001; 95% CI 1.001-1.002, P = 0.002), placenta accreta (OR: 68; 95% CI 10-456, P = 0.004), the use of tocolytic agents prenatally (OR: 6.55, 95%CI 1.34-32.1,P = 0.049), and fetal macrosomia (OR: 6.9, 95% CI 1.25-38, P = 0.049).
  
  
  CONCLUSIONS
  Significant risk factors of EPH are DIC, placenta previa, PPH, previous cesarean delivery, and placenta accrete, the use of tocolytic agents prenatally, and fetal macrosomia.
authors.affiliation: Department of Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200030, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Jin
authors.affiliation: Department of Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200030, China.
authors.forename: Yuna
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200030, China. Email: drchenyixin@hotmail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004630:Emergencies; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology; D010921:Placenta Accreta / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000601:surgery; D011247:Pregnancy; D012307:Risk Factors; D015149:Tocolytic Agents / Q000009:adverse effects
chemical_list: D015149:Tocolytic Agents