Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Jul;114(1):115-123.
doi: 10.1097/AOG.0b013e3181a81cdd.

Factors associated with peripartum hysterectomy

Clara Bodelon  1 , Antonio Bernabe-Ortiz, Melissa A Schiff, Susan D Reed
Affiliations

Factors associated with peripartum hysterectomy

Clara Bodelon et al. Obstet Gynecol. 2009 Jul.

Abstract

Objective: To identify factors associated with peripartum hysterectomy performed within 30 days postpartum.

Methods: This was a population-based case-control study using Washington State birth certificate registry (1987-2006) linked to the Comprehensive Hospital Abstract Reporting System. Cases underwent hysterectomy within 30 days postpartum. Controls were frequency matched 4:1. Exposures included factors related to hemorrhage, delivery method, multiple gestations, and infection. Incidence rates of peripartum hysterectomy and maternal and neonatal morbidity and mortality were assessed. Adjusted odds ratios (aORs) by maternal age, parity, gestational age, year of birth, and mode of delivery and 95% confidence intervals (CIs) were computed.

Results: There were 896 hysterectomies. Incidence rates ranged from 0.25 in 1987 to 0.82 per 1,000 deliveries in 2006 (chi for trend, P<.001). Factors related to hemorrhage were strongly related to peripartum hysterectomy. Placenta previa (192 cases compared with 23 controls; aOR 7.9, 95% CI 4.1-15.0), abruptio placenta (71 compared with 55; aOR 3.2, 95% CI 1.8-5.8), and retained placenta (214 compared with 28; aOR 43.0, 95% CI 19.0-97.7) increased the risk of hysterectomy, as did uterine atony, uterine rupture, and thrombocytopenia. Having multiple gestations did not. As compared with vaginal delivery, vaginal delivery after cesarean (27 cases compared with 105 controls; aOR 1.9, 95% CI 1.2-3.0), primary cesarean (270 compared with 504; aOR 4.6, 95% CI 3.5-6.0), and repeat cesarean (296 compared with 231; aOR 7.9, 95% CI 5.8-10.7) increased the risk of peripartum hysterectomy. Among the 111 women who had hysterectomy on readmission (12.8% of cases), hemorrhage- and infection-related factors were still strongly associated with peripartum hysterectomy.

Conclusion: Incidence rates of peripartum hysterectomy are increasing over time. The most important risk factor for peripartum hysterectomy is hemorrhage, most notably caused by uterine rupture, retained placenta, and atony of uterus.

Level of evidence: II.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Trends of peripartum hysterectomy in Washington State from 1987 to 2006. The dashed lines represent the 95% confidence intervals.
See this image and copyright information in PMC

Comment in

References

    1. Briery CM, Rose CH, Hudson WT, et al. Planned vs emergent cesarean hysterectomy. Am J Obstet Gynecol. 2007;197:154.e1–154.e5. - PubMed
    1. Knight M. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG. 2007;114:1380–1387. - PubMed
    1. Engelsen IB, Albrechtsen S, Iversen OE. Peripartum hysterectomy-incidence and maternal morbidity. Acta Obstet Gynecol Scand. 2001;80:409–412. - PubMed
    1. Selo-Ojeme DO, Bhattacharjee P, Izuwa-Njoku NF, Kadir RA. Emergency peripartum hysterectomy in a tertiary London hospital. Arch Gynecol Obstet. 2005;271:154–159. - PubMed
    1. Forna F, Miles AM, Jamieson DJ. Emergency peripartum hysterectomy: a comparison of cesarean and postpartum hysterectomy. Am J Obstet Gynecol. 2004;190:1440–1444. - PubMed