Risk factors and management patterns for emergency obstetric hysterectomy over 2decades

Abstract 

Objective

To review the demographic characteristics of patients, risk factors, indications, and complications of emergency obstetric hysterectomy (EOH), and to determine the changing trends in EOH over the last 2decades.

Methods

A retrospective review of all consecutive cases of EOH over the last 20years at Mayday University Hospital, UK.

Results

There were 84698 deliveries between January 1989 and January 2009. Fifty-two women had an EOH, with an incidence of 0.6 per 1000 deliveries. The underlying cause of EOH was uncontrolled primary hemorrhage in 50 (96.2%) women and severe sepsis leading to secondary hemorrhage in 2 (3.8%) women. A total of 38 (73%) EOHs were performed for intractable bleeding after cesarean delivery. Twenty-five EOHs were performed in the first decade, and 27 EOHs were performed in last decade.

Conclusion

Despite the introduction of pharmacologic agents and new surgical techniques to control postpartum hemorrhage, there was no reduction in the prevalence of EOH. Previous cesarean delivery with associated placenta previa or placenta accreta was a major contributor toward EOH.

Keywords: Cesarean delivery, Emergency obstetric hysterectomy, Major obstetric hemorrhage, Placenta accreta, Placenta previa