title: Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review.
abstract: OBJECTIVE
  To determine incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a tertiary teaching hospital and to compare the results with literature data.
  
  
  METHODS
  Retrospective study of 51 patients who underwent EPH at the Department of Gynecology, Obstetrics and Urology of the University of Rome Sapienza, from January 2000 to December 2013. Maternal characteristics of the index pregnancy and delivery, indications for EPH, operative and postoperative complications, maternal and neonatal outcome were acquired by the hospital records. Fisher's and Chi-square tests were performed for statistical analysis.
  
  
  RESULTS
  There were 51 EPH out of 23,384 deliveries, for an incidence of 2.2 per 1,000 deliveries during the study period. Forty-nine EPHs were performed after caesarean delivery (CS) and two after vaginal delivery (p < 0.0001). The most common indications were abnormal placentation (49.0%), followed by uterine atony (41.2%), and uterine rupture (9.8%). Eighty percent of patients who underwent EPH with abnormal placentation had at least one previous CS (p < 0.01). Twenty-three patients (45.1%) underwent total hysterectomy, the most frequent indication being abnormal placentation (76%, p < 0.01). The remaining 28 patients underwent subtotal hysterectomy (54.9%), the most frequent indication being uterine atony (85.7%, p < 0.01). Maternal morbidity was 25.5% and mortality was 5.9%. Perinatal mortality was 3.9%.
  
  
  CONCLUSIONS
  Abnormal placentation was the most common indication for EPH, requiring in most of the cases a total hysterectomy. Previous CS was a risk factor for abnormal placentation and in particular for pathological adherence of the placenta. EPH remains associated with a high incidence of morbidity and mortality.
authors.affiliation: Department of Gynecology, Obstetrics and Urology, Policlinico Umberto I, University "Sapienza", Viale del Policlinico, 155, 00155, Rome, Italy, stella.darpe@gmail.com.
authors.forename: Stella
authors.initials: S
authors.lastname: D'Arpe
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Corosu
authors.forename: Innocenza
authors.initials: I
authors.lastname: Palaia
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.forename: Giorgia
authors.initials: G
authors.lastname: Perniola
authors.forename: Ludovico
authors.initials: L
authors.lastname: Muzii
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D015994:Incidence; D008428:Maternal Mortality; D054238:Perinatal Mortality; D058725:Peripartum Period; D010929:Placentation; D011183:Postoperative Complications; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014593:Uterine Inertia / Q000453:epidemiology / Q000601:surgery*; D014597:Uterine Rupture / Q000453:epidemiology / Q000601:surgery