Emergency postpartum hysterectomy: incidence, trends, indications, and complications

Abstract

Aim: The aim of this study was to investigate the incidence of, indications for, and risk factors associated with emergency postpartum hysterectomy. Methods: Thirteen cases of emergency postpartum hysterectomy performed at Hachioji Medical Center of Tokyo Medical University (HMC) between January 1998 and February 2012 were evaluated retrospectively. Results: Emergency postpartum hysterectomy was performed in 13 of 42,119 deliveries (0.31 per 1,000 deliveries). Uterine rupture was the most frequent indication (38.5%). Disseminated intravascular coagulopathy was the most frequent pre-and postoperative complication. It was evident that the incidence of emergency postpartum hysterectomy decreased upon introduction of active recombinant factor VII and uterine artery embolism in HMC (to 0.15 per 1,000 deliveries). Conclusion: Emergency postpartum hysterectomy remains an effective procedure for managing postpartum hemorrhage. However, our findings suggest that new procedures can contribute to reducing the need for emergency postpartum hysterectomy.