title: Emergency peripartum hysterectomy and risk factors by mode of delivery and obstetric history: a 10-year review from Helsinki University Central Hospital.
abstract: OBJECTIVE
  This study aims to estimate the occurrence of emergency peripartum hysterectomy (EPH) and to quantify its risk factors in connection with the mode of delivery and the obstetric history of patients at the Helsinki University Central Hospital, Finland.
  
  
  METHODS
  In a retrospective, matched case-control study we identified 124 cases of EPH from 2000 to 2010 at our hospital. These were matched with 248 control patients.
  
  
  RESULTS
  The incidence rate of EPH was 9.9/10,000. Patients whose current delivery was vaginal, and had a cesarean section (CS) in their history had a six-fold risk for EPH. Women who underwent their first CS had a nine times higher risk, while patients who currently underwent CS and had a history of previous CS, had a 22 times higher risk. Those who experienced prostaglandin-E1 induction had a five-fold risk. Maternal age >35 years, previous curettage, and twin pregnancy were identified as significant risk factors. In 41 cases, interventions to reduce bleeding were performed.
  
  
  CONCLUSIONS
  Obstetric emergency training and guidelines for massive hemorrhage should be established in any delivery department. Moreover, all possible precautions should be taken to avoid the first CS if it is obstetrically unnecessary. Induction with prostaglandin-E1, maternal age >35 years, previous curettage, twin pregnancies, and early gestation were identified as risk factors for EPH.
authors.forename: Georg
authors.initials: G
authors.lastname: Macharey
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Ulander
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
authors.forename: Mervi
authors.initials: M
authors.lastname: Väisänen-Tommiska
authors.forename: Volker
authors.initials: V
authors.lastname: Ziller
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D004630:Emergencies; D005260:Female; D005387:Finland; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D016015:Logistic Models; D015999:Multivariate Analysis; D058725:Peripartum Period; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors