Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review

Abstract

Introduction Our objective was to determine the incidence and mortality rates associated with emergency peripartum hysterectomy, factors that lead to uncontrolled hemorrhage and emergency peripartum hysterectomy, and to determine the relationship between cesarean section and risk of emergency peripartum hysterectomy. Materials and methods Studies published between January 1, 2000 and December 31, 2012 were identified using PubMed, OVID and Web of Science databases. Studies were included if they reported incidence rates for emergency peripartum hysterectomy, factors that lead to hemorrhage and emergency peripartum hysterectomy, or the association of emergency peripartum hysterectomy with cesarean section in high-income countries. Results Four hundred and fifty-one studies were identified, and 52 were included. The incidence of emergency peripartum hysterectomy ranged from 0.20 to 5.09 per 1000 deliveries with a median incidence rate of 0.61 per 1000 deliveries. These rates have increased over time. Rates varied by region/country, specifically with the United States reporting higher rates than North American, Asian, Oceania, and European countries. The most common factor leading to emergency peripartum hysterectomy was placental abnormalities. Both cesarean section and prior cesarean section were strong risk factors for emergency peripartum hysterectomy with higher risks conferred for each additional cesarean section. The mean percentage of maternal deaths for EPH survivors was 3.0 %. Conclusion Given the association of cesarean section with emergency peripartum hysterectomy, the increased risk of emergency peripartum hysterectomy should be factored into the decision of whether to proceed with cesarean delivery, particularly for women who desire more children.

Obstetric hysterectomy: an emergency lifesaving procedure

“…10 It is known from multiple studies, that caesarean section is associated with an increased risk of EPH. [11][12][13][14][15][16][17][18] This was confirmed by a recent systematic review from de la Cruz et al 1 The authors identified that Caesarean section, either as a previous history or as the current mode of delivery, was strongly and consistently associated with an increased risk of EPH. 1 Stanco et al reported that 43.4% of their emergency hysterectomies were done because of uterine atony, while 33.9% were due to placenta previa with accreta .19 A study from the same institution in 1993 stated that their primary indication was placenta accreta, the problem in 45% of cases, followed by uterine atony, with 20%.…”

“…1 Amongst the recently published studies from India, the reported incidence rates range from 0.83 to 3.9 per 1000 deliveries. [5][6][7][8][9] The observations from our study are consistent with these findings, and suggest a relatively fair incidence rate; however, the number of surgeries required in 2013, was nearly two-fold higher as compared to the previous year.…”

“…Although traditionally, uterine atony has been the leading indication for EPH, recent studies do suggest an increasing trend of abnormal placentation, associated with more frequent Caesarean section deliveries. 1,2 Since the obstetrics practice trends may significantly influence the need and outcome of EPH, a periodic Department of Obstetrics and Gynaecology, Seth G. S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India monitoring of this evidence, would provide valuable insights for the current management practices in obstetrics.…”

Emergency Peripartum Hysterectomy: 20-Year Experience of a University Hospital

“…Obstetrik kanama ayrıca Türkiye gibi gelişmekte olan ülkelerde maternal mortalitenin en önemli sebebidir. Türkiye Cumhuriyeti Sağlık Bakanlığı'nın Hacettepe Üniversitesi ile beraber yaptığı Ulusal Anne Ölümleri çalışmasına göre Türkiye'de anne ölümlerinin en önemli sebebi obstetrik kanamalardır (%25) (7) (4,5,(20)(21)(22)(23). Bu değişim artan sezaryen hızları ile birlikte plasental anomalilerin (plasenta previa ve invazyon anomalileri) artmasına ikincil gerçekleşmektedir.…”

Risk factors for transfusion in cesarean section deliveries at a tertiary hospital

“…Factors including maternal age, multiparity, abnormal placentation, placental abruption, severe preeclampsia, previous cesarean delivery, fetal macrosomia, and uterine fibroids have been associated with PPH . Previous studies confirm that placental abnormalities are the most common factor leading to an emergency peripartum hysterectomy …”