title: Clinical analysis of emergency peripartum hysterectomies in a tertiary center.
abstract: OBJECTIVE
  To investigate the incidence, indications, complications, and risk factors associated with increased mortality and morbidity of emergency peripartum hysterectomy (EPH).
  
  
  METHODS
  The authors retrospectively analyzed 48 cases of EPH performed within six-year interval at Ondokuz Mayis University Hospital. EPH was defined as the operation performed for life-threatening hemorrhage which could not be controlled with conservative treatment modalities within 24 hours of a delivery.
  
  
  RESULTS
  The incidence of EPH was 5.03 per 1,000 deliveries. The most common indication for EPH was abnormal placental adherence (n = 22, 45.8%), followed by uter- ine atony (n = 19, 39.6%). All the patients with placenta accreta had a history of repeat cesarian section (CS) and placenta previa.Total hysterectomy was performed in almost all of the patients (n = 47, 97.9%). All women required blood transfusions. Maternal morbidity was significant, with bladder injury (31.3%) and disseminated intravascular coagulation (18.7%) among the most common complications. There were one maternal (2.1%) and five neonatal deaths (10.4%).
  
  
  CONCLUSIONS
  Since most of the EPH cases are associated with prior cesarean delivery, decision of the first CS should be made for true obstetrical indications.If conservative treatments fail to control massive obstetrical bleeding, blood products and an experienced obstetrician should be ready to perform EPH to decrease the maternal mor- bidity and mortality.
authors.affiliation: Department of Obstetrics and Gynecology,  Akdeniz University Medical Faculty, Antalya, Turkey. mehmetsakinci@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Sakinci
authors.forename: O
authors.initials: O
authors.lastname: Kuru
authors.forename: M
authors.initials: M
authors.lastname: Tosun
authors.forename: A
authors.initials: A
authors.lastname: Karagoz
authors.forename: H
authors.initials: H
authors.lastname: Celik
authors.forename: F D
authors.initials: FD
authors.lastname: Bildircin
authors.forename: E
authors.initials: E
authors.lastname: Malatyalioglu
mesh_terms: D000328:Adult; D004630:Emergencies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D058725:Peripartum Period; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D062606:Tertiary Care Centers