Document Detail


Peripartum cesarean hysterectomy: critical analysis of risk factors and trends over the years.
MedLine Citation:
PMID:  20636233     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Objective.?To investigate time trends and risk factors for peripartum cesarean hysterectomy. Methods.?A population-based study comparing all deliveries that were complicated with peripartum hysterectomy to deliveries without this complication was conducted. Deliveries occurred during the years 1988?2007 at a tertiary medical center. A multiple logistic regression model was constructed to find independent risk factors associated with peripartum hysterectomy. Results.?Emergency peripartum cesarean hysterectomy complicated 0.06% (n?=?125) of all deliveries in the study period (n?=?211,815). The incidence of peripartum hysterectomy increased over time (1988?1994, 0.04%; 1995?2000, 0.05%; 2001?2007, 0.095%). Independent risk factors for emergency peripratum hysterectomy from a backward, stepwise, multivariable logistic regression model were: uterine rupture (OR?=?487; 95% CI 257.8?919.8, p?<?0.001), placenta previa (OR?=?66.4; 95% CI 39.8?111, p?<?0.001), postpartum hemorrhage (PPH) (OR?=?40.8; 95% CI 22.4?74.6, p?<?0.001), cervical tears (OR?=?22.3; 95% CI 10.4?48.1, p?<?0.001), second trimester bleeding (OR?=?6; 95% CI 1.8?20, p?=?0.003), previous cesarean delivery (OR?=?5.4; 95% CI 3.5?8.4, p?<?0.001), placenta accreta (OR?=?4.7; 95% CI 1.9?11.7, p?=?0.001), and grand multiparity (above five deliveries, OR?=?4.1; 95% CI 2.5?6.6, p?<?0.001). Newborns of these women had lower Apgar scores (<7) at 1 and 5?min (32.7% vs.4.4%; p?<?0.001, and 10.5% vs. 0.6%; p?<?0.001, respectively), and higher rates of perinatal mortality (18.4% vs. 1.4%; p?<?0.001) as compared to the comparison group. Conclusion.?Significant risk factors for peripartum hysterectomy are uterine rupture, placenta previa, PPH, cervical tears, previous cesarean delivery, placenta accreta, and grand multiparity. Since the incidence rates are increasing over time, careful surveillance is warranted. Cesarean deliveries in patients with placenta previa-accreta, specifically those performed in women with a previous cesarean delivery, should involve specially trained obstetricians, following informed consent regarding the possibility of peripartum hysterectomy.
Authors:
Adi Orbach; Amalia Levy; Arnon Wiznitzer; Moshe Mazor; Gershon Holcberg; Eyal Sheiner
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Publication Detail:
Type:  Journal Article     Date:  2010-07-19
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  24     ISSN:  1476-4954     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  480-4     Citation Subset:  IM    
Affiliation:
Faculty of health sciences, Ben Gurion University of the Negev, Be?er-Sheva, Israel.
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