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. 2009 Jun;200(6):632.e1-6.
doi: 10.1016/j.ajog.2009.02.001.

Changing trends in peripartum hysterectomy over the last 4 decades

Karen M Flood  1 , Soha Said, Michael Geary, Michael Robson, Christopher Fitzpatrick, Fergal D Malone
Affiliations

Changing trends in peripartum hysterectomy over the last 4 decades

Karen M Flood et al. Am J Obstet Gynecol. 2009 Jun.

Abstract

Objective: The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years.

Study design: A retrospective cohort study was performed from 1966-2005 of patients who had PH in any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained from the combined patient databases of each hospital.

Results: There were 872,379 deliveries during the study period, among which 358 women underwent PH (0.4/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005, PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the overall cesarean delivery rate has increased from 6-19% during these 2 decades, the percentage of PH that occurs in the setting of a previous cesarean delivery has increased from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with "uterine rupture" as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5% (P < .00001).

Conclusion: PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery rate, there has been a marked increase in the incidence of placenta accreta.

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