Risk factors for cesarean hysterectomy in tertiary center in Thailand: a case-control study

Abstract

Aim: To identify the risk factors for cesarean hysterectomy in a tertiary center in Bangkok, Thailand.

Methods: A case-control study was conducted by reviewing the medical records of pregnant women delivered at BMA Medical College and Vajira Hospital between 1 January 2001 and 28 February 2007. The case refers to pregnant women who underwent hysterectomy immediately or within 24 h following cesarean delivery. Controls included pregnant women who received cesarean section during the same study period by a ratio of 1:5 (case : control).

Results: During the study period, cesarean hysterectomy complicated 30 deliveries out of 31 106 deliveries (0.96:1000). Independent risk factors for cesarean hysterectomy from a multivariate logistic regression analysis were placental adherence (odds ratio [OR] = 440, 95% confidence interval [CI] 28-7000), placenta previa (OR = 57, 95% CI 6.0-540) and uterine atony (OR = 37, 95% CI 7.5-190). Sixty-three percent (5/8) of placental adherence were associated with placenta previa. Of these five patients, four had a uterine scar from a prior cesarean section. The following outcomes were significantly higher in the cesarean hysterectomy group as compared to the controls: operative time, blood loss, hypovolemia, coagulopathy, transfusions, febrile morbidity, secondary surgery, and duration of hospitalization.

Conclusion: Placental adherence, placenta previa and uterine atony were identified as significant risk factors for cesarean hysterectomy. Cesarean section due to placenta previa should be electively scheduled with well-prepared blood components. The obstetrician should provide counsel and obtain detailed informed consent with regard to the possibility of cesarean hysterectomy.