Maternal characteristics, clinical indications, and neonatal outcomes in cesarean hysterectomy: A cross-sectional study.

Abstract

Background: Cesarean hysterectomy (CH) is a life-saving surgical procedure performed in obstetric emergencies, particularly in cases of uncontrollable hemorrhage, placenta previa, and abnormal placental adherence.

Objective: This study aimed to evaluate the maternal characteristics, associated clinical factors, complications, and neonatal outcomes observed in CH.

Materials and methods: In this cross-sectional study, data of 89 women who underwent CH at Sayad Shirazi hospital, Gorgan, Iran, between 2013 and 2022 were extracted from participants' medical records using a structured checklist covering maternal demographics, comorbidities, placental conditions, surgical outcomes, and neonatal results.

Results: The mean maternal age was 34.65 $\pm$ 5.2 yr, body mass index 28.78 $\pm$ 3.4 kg/m², and gestational age 34.54 $\pm$ 3.2 wk. Placenta previa was present in 88.6% of cases, with placenta increta (46.1%), accreta (29.2%), and percreta (21.3%) being the most common placenta accreta spectrum subtypes. Preoperative and postoperative hemoglobin levels were 11.2 $\pm$ 1.8 and 8.15 $\pm$ 1.56 g/dL, respectively. Blood transfusion was required in 94.4% of cases. Intensive care unit admission was required in 93.3%, with a mean stay of 2.01 $\pm$ 0.11 days. Intraoperative organ injury occurred in 20.2% of cases. Mean neonatal birth weight was 2414.61 $\pm$ 682 gr, with 68.1% requiring neonatal intensive care unit admission primarily due to prematurity. No maternal or neonatal deaths occurred.

Conclusion: Placenta previa and placenta accreta spectrum disorders are the primary risk factors for CH. Adequate preparation, including blood product reserves and intensive care unit/neonatal intensive care unit availability, is essential for managing these high-risk cases. As a descriptive study without a comparison group, these findings reflect observed patterns rather than causal associations.