Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage

Abstract

Objectives: To identify women undergoing peripartum hysterectomy in the UK and to describe the causes, management and outcome of the associated haemorrhage.

Design: A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS).

Setting: All 229 hospitals with consultant-led maternity units in the UK.

Population: All women in the UK delivering between February 2005 and February 2006.

Methods: Prospective case identification through the UKOSS monthly mailing.

Main outcome measures: Rates with 95% CIs. Odds ratio estimates.

Results: Three hundred and eighteen women underwent peripartum hysterectomy. The most commonly reported causes of haemorrhage were uterine atony (53%) and morbidly adherent placenta (39%). Women were not universally managed with uterotonic therapies. Fifty women were unsuccessfully managed with B-Lynch or other brace suture prior to hysterectomy, 28 with activated factor VII and 9 with arterial embolisation. Twenty-one percent of women suffered damage to other structures, 20% required a further operation and 19% were reported to have additional severe morbidity. Bladder damage was more likely in women with placenta accreta (OR 3.41, 95% CI 1.55-7.48) than in women with uterine atony. There were no significant differences in outcomes between women undergoing total or subtotal hysterectomy. Two women died; case fatality 0.6% (95% CI 0-1.5%).

Conclusions: For each woman who dies in the UK following peripartum hysterectomy, more than 150 survive. The associated haemorrhage is managed in a variety of ways and not universally according to existing guidelines. Further investigation of the outcomes following some of the more innovative therapies for control of haemorrhage is needed.