Peripartum hysterectomy and associated factors.

OBJECTIVE To identify the risk factors associated with peripartum hysterectomy. STUDY DESIGN The charts of 101 cesarean hysterectomies performed at Severance Hospital from January 1986 to April 2001 were reviewed. The patients were categorized into 2 groups. One was patients who underwent vaginal delivery followed by peripaRtum hysterectomy. The other was those who had cesarean section followed by peripartum hysterectomy. Paired t test and one-way ANOVA were used for statistical analysis. RESULTS During the study period there were 31,044 deliveries. Peripartum hysterectomy was performed in 54 of 11,924 cesarean sections (0.45%) and 18 of 19,120 vaginal deliveries (0.09%). The most common indication for peripartum hysterectomy was uterine atony (41.58%), followed by placenta previa accreta (23.76%), placenta accreta (16.83%) and placenta previa (11.88%). Placenta previa accreta patients received the highest volume of transfusions, 1,734 +/- 688 mL (P < .05). More cesarean hysterectomies (55.93%) occurred in emergency cesarean section cases than in elective ones (44.06%). CONCLUSION The risk factors associated with peripartum hysterectomy were placental abnormalities and previous cesarean deliveries. Hemorrhage remained the main cause of maternal mortality. Therefore, peripartum hysterectomy must be performed to save the life of the mother and must be free of dangerous sequelae.