Emergency peripartum hysterectomy as postpartum hemorrhage treatment: Incidence, risk factors, and complications

Abstract

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period. Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR)=18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR)=9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR=152 (95% CI 43.7-528.4), AOR=45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR=5.5 (95% CI 2.9-9.7), AOR=3.7 (95% CI1.4-9.9); (iv) uterine atony, OR=11.9 (95% CI 5.8-24.6), AOR=7.5 (95% CI 1.8-30.2); (v) placenta previa, OR=2.04 (95% CI 1.1-3.5), AOR=none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.