title: Review of peripartum hysterectomy rates at a tertiary Australian hospital.
abstract: BACKGROUND
  Peripartum hysterectomy is commonly performed for catastrophic postpartum haemorrhage uncontrolled by conservative medical and surgical therapies. Currently, information about the incidence and indications for peripartum hysterectomy are not well defined in Australia.
  
  
  OBJECTIVE
  Evaluate the incidence and indications of peripartum hysterectomy in the Royal Brisbane and Women's Hospital (RBWH) between 2000 and 2014.
  
  
  METHODS
  A 15-year retrospective cohort study of peripartum hysterectomies at RBWH was conducted. The incidence of this event was calculated. Risk factors for abnormal placentation were explored using univariate analyses. Statistical significance was declared at α < 0.05.
  
  
  RESULTS
  A total of 83 cases of peripartum hysterectomy were reviewed. The incidence of peripartum hysterectomy was 0.60 per 1000 births after discounting the 44 (53%) cases of peripheral regional hospital referrals. Abnormal placentation and uterine atony constituted the majority of the indications for peripartum hysterectomy. Abnormal placentation included placenta praevia, accrete, increta and percreta. In this cohort with peripartum hysterectomy, previous caesarean section was strongly associated with abnormal placentation (P < 0.001, OR 11.4, 95% CI 3.6-35.8). No maternal mortality was recorded, although 63% of patients encountered complications. A planned peripartum hysterectomy resulted in significantly fewer red blood cell (P = 0.011) and platelet transfusions (P = 0.001).
  
  
  CONCLUSIONS
  The incidence of peripartum hysterectomy recorded in our tertiary institution between 2000 and 2014 is 0.60 per 1000 births. Abnormal placentation is the commonest indication leading to severe postpartum haemorrhage requiring peripartum hysterectomy.
authors.affiliation: Department of Obstetrics & Gynaecology, Royal Brisbane and Women's Hospital, Queensland, Australia.
authors.forename: Hon C
authors.initials: HC
authors.lastname: Cheng
authors.affiliation: QIMR Berghofer Medical Research Institute, Queensland, Australia.
authors.forename: Anita
authors.initials: A
authors.lastname: Pelecanos
authors.affiliation: Centre for Advanced Prenatal Care, Royal Brisbane and Women's Hospital, Queensland, Australia.
authors.forename: Renuka
authors.initials: R
authors.lastname: Sekar
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D007902:Length of Stay; D058725:Peripartum Period; D010921:Placenta Accreta / Q000601:surgery*; D010923:Placenta Previa / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D011793:Queensland; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014593:Uterine Inertia / Q000601:surgery*
keywords: Queensland; abnormal placentation; peripartum hysterectomy; postpartum haemorrhage; uterine atony