title: Exaggerated placental site/placental site trophoblastic tumor: an underestimated risk factor for emergency peripartum hysterectomy.
abstract: OBJECTIVE
  To assess the indications and possible underlying causes of emergency peripartum hysterectomy (EPH) at the present hos- pital during the 2001-2011 period.
  
  
  METHODS
  A revision of the charts and pathology reports corresponding to 42,728 parturients.
  
  
  RESULTS
  During the study period, 25 peripartum hysterectomies were performed (0.61/1.000), of which 23 were EPHs (0.54/1.000) and two were planned cesarean hysterectomies. The indication for EPH was acute postpartum hemorrhage in 22 of 23 instances (95.7%). Roughly two-thirds of the operated uteri (16/25, 64%) showed placental site anomalies, half corresponding to different degrees of placental accretism and half to anomalies derived from the implantation site intermediate trophoblast. In five cases (31%), the anomaly was an exaggerated placental site and three cases corresponded to placental site trophoblastic tumors. Of the 16 cases showing placental site anomalies, ten (62.5%) were associated with one or more previous cesarean sections.
  
  
  CONCLUSIONS
  Roughly one-third of EPHs performed at the present center during the last ten years were associated with placental site anomalies originating in the implantation site intermediate trophoblast (exaggerated placental site and placental site trophoblastic tumor). This association has not been described before, and should be taken into consideration when facing acute peripartum hemorrhage predisposing to EPH.
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: De Miguel
authors.forename: R
authors.initials: R
authors.lastname: Quintana
authors.forename: I
authors.initials: I
authors.lastname: González-Rodilla
authors.forename: J M
authors.initials: JM
authors.lastname: Odriozola
authors.forename: J
authors.initials: J
authors.lastname: Schneider
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D058725:Peripartum Period; D006473:Postpartum Hemorrhage / Q000601:surgery; D011247:Pregnancy; D012307:Risk Factors; D018245:Trophoblastic Tumor, Placental Site / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*