Indications for and outcomes of emergency peripartum hysterectomy - A five-year review

OBJECTIVE: To review risk factors, management and outcomes of emergency per ipartum hysterectomy performed in the last five years at Stony Brook Univer sity Hospital. STUDY DESIGN: Retrospective descriptive and cohort analyses from January 19 90 to January 1995. Incidences of emergency peripartum hysterectomy and pla centa accreta were determined. Relative risks of hysterectomy for specified risk factors were calculated. RESULTS: There were 39 cases of emergency peripartum hysterectomy, for an o verall incidence of 2.7/1,000 births. Indications for emergency hysterectom y were placenta accreta, unspecified bleeding, uterine rupture, myomas and atony with placenta accreta, the most common. The crude relative risk of em ergency hysterectomy was 46.9 (n = 37)for cesarean delivery, 15.24 (n = 31) for prior cesarean delivery and 110.83 (n = 21) for placenta previa. CONCLUSION: Cesarean delivery, prior cesarean delivery, placenta accreta an d uterine atony were identified as risk factors for Emergency peripartum hy sterectomy, and abnormal placentation was the primary cause of cesarean hys terectomy.