title: Changing trends in emergency peripartum hysterectomy in a tertiary obstetric center in Turkey during 2000-2013.
abstract: OBJECTIVE
  To evaluate emergency peripartum hysterectomy (EPH) cases over a 14-year period in a tertiary center in İstanbul, Turkey.
  
  
  METHODS
  In this retrospective descriptive study, the records of all cases of EPH performed at the Zeynep Kamil Women and Children's Training and Research Hospital between January 2000 and January 2014 were analyzed. Results for 2000-2006 and 2007-2013 were compared to identify changing trends. Demographic and clinical factors associated with EPH were assessed.
  
  
  RESULTS
  During the 14-year study period, a total of 161,836 births occurred, out of which 104,783 (64.8%) were vaginal deliveries and 57,053 (35.2%) were cesarean section (CS). EPH was performed in 81 patients with an overall incidence of 0.5 in 1000 deliveries. The EPH rate in 2007-2013 (0.07%) was significantly higher than in 2000-2006 (0.03%). The major difference in the EPH populations between the two periods was the higher number of previous CS in 2007-2013 compared with 2000-2006 (p=0.01). Indications for EPH did not differ between the two periods. There were 7 (8.6%) maternal deaths in 2000-2013, with significantly fewer maternal deaths in 2007-2013 than in 2000-2006 (19.2% vs. 3.6%).
  
  
  CONCLUSIONS
  Rate of EPH increased considerably from 2000 to 2013. This increase was mostly related to the increasing rate of CS. Indications for EPH did not change over the study period, and the number of maternal deaths markedly decreased.
authors.affiliation: Department of Obstetrics and Gynecology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Temizkan
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Training and Research Hospital, İstanbul, Turkey.
authors.forename: Doğukan
authors.initials: D
authors.lastname: Angın
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Training and Research Hospital, İstanbul, Turkey.
authors.forename: Resul
authors.initials: R
authors.lastname: Karakuş
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Training and Research Hospital, İstanbul, Turkey.
authors.forename: İlhan
authors.initials: İ
authors.lastname: Şanverdi
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Training and Research Hospital, İstanbul, Turkey.
authors.forename: Mesut
authors.initials: M
authors.lastname: Polat
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Training and Research Hospital, İstanbul, Turkey.
authors.forename: Ateş
authors.initials: A
authors.lastname: Karateke
keywords: Postpartum hemorrhage; emergency peripartum hysterectomy; placenta accreta; trend