title: Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study.
abstract: OBJECTIVE
  To estimate the incidence of emergency peripartum hysterectomy over 6 years in Ain-shams University Maternity Hospital.
  
  
  METHODS
  Detailed chart review of all cases of emergency peripartum hysterectomy, 2003-2008, including previous obstetric history, details of the index pregnancy, indications for emergency peripartum hysterectomy, outcome of the hysterectomy and infant morbidity.
  
  
  RESULTS
  The overall rate of emergency peripartum hysterectomy was 149 of 66,306 or 2.24 per 1,000 deliveries. The primary indications for hysterectomies were placenta accreta/increta 59 (39.6 %), uterine atony 37 (24.8 %), uterine rupture 35 (23.5 %) and placenta previa without accreta 18 (12.1 %). After hysterectomy, 115 (77 %) women were admitted to the intensive care unit. Women were discharged home after a mean 11.2 day length of stay. Using multifactorial logistic regression analysis, we found that woman's age, atonic uterus, placenta accreta/increta, previous cesarian section and ruptured uterus were independent predictors for peripartum hysterectomy
  
  
  CONCLUSIONS
  Abnormal placentation was the main indication for peripartum hysterectomy. The risk factors for peripartum hysterectomy were morbid adherence of placentae in scared uteri, uterine atony and uterine rupture. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk. The risk of peripartum hysterectomy seems to be significantly decreased by limiting the number of cesarean section deliveries, thus reducing the occurrence of abnormal placentation in the form of placenta accreta, increta or percreta.
authors.affiliation: Obstetrics and Gynaecology Department, Ain-shams Faculty of Medicine, Ain Shams University Maternity Hospital, Abbasiya square, Cairo, Egypt, ihabserag@hotmail.com.
authors.forename: Ihab Serag
authors.initials: IS
authors.lastname: Allam
authors.forename: Ihab Adel
authors.initials: IA
authors.lastname: Gomaa
authors.forename: Hisham Mohamed
authors.initials: HM
authors.lastname: Fathi
authors.forename: Ghada Fathi Mahmoud
authors.initials: GF
authors.lastname: Sukkar
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D004534:Egypt / Q000453:epidemiology; D004630:Emergencies / Q000453:epidemiology*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D007902:Length of Stay; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000601:surgery*; D058725:Peripartum Period; D010921:Placenta Accreta / Q000453:epidemiology / Q000601:surgery; D010923:Placenta Previa / Q000453:epidemiology / Q000601:surgery; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014593:Uterine Inertia / Q000453:epidemiology / Q000601:surgery; D014597:Uterine Rupture / Q000601:surgery