Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide

Abstract

Emergency peripartum hysterectomy is associated with considerable morbidity and mortality and is more frequent in lower-income countries, where it contains a higher risk of mortality. A (previous) cesarean delivery is associated with a higher risk of emergency peripartum hysterectomy.

The Relevance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates

“…These patients, after their primary cesarean delivery, will therefore inevitably proceed to a trial of VBAC, and since such a high proportion of our pa-DOI: 10.1159/000493362 tients refuse to undergo VBAC for reasons previously outlined, a second cesarean delivery will be performed which therefore adds to the high institutional cesarean delivery rate reported in this study. The decision to perform a second cesarean delivery will most likely lead to another cesarean delivery, and multiple repeat cesarean deliveries; this will ultimately lead to the complex interplay of factors leading to the various problems associated with multiple cesarean deliveries including placenta praevia/accreta, primary postpartum hemorrhage, cesarean hysterectomy, maternal morbidity, and probable maternal mortality [31][32][33]. This unfortunate trend is gradually increasing in our institution and causing great concern.…”

“…Increasing number of cesarean deliveries in a patient (which will start from a primary cesarean delivery and then repeat cesarean deliveries with no VBAC) has contributed to the rising incidences of placenta praevia/accreta with the additional consequences of primary postpartum hemorrhage, increased cesarean hysterectomy and other hazards including maternal morbidity and mortality. A recent study [31] showed that placenta praevia/accreta, a frequently reported cause of primary postpartum hemorrhage, was associated with a high risk of peripartum hysterectomy; other studies [32,33] had also reported an increased risk of hysterectomy in patients with placental pathologies (which include placenta praevia/accreta) and cesarean sections.…”

Pattern of Peripartum Haemorrhage in a Tertiary Care Centre

“…In a systematic review of 128 studies hysterectomy complicated almost 1 per1000 deliveries (11) .In this study it is 2 per 1000 deliveries. The higher prevalence in this study may be due to the reference of all high risk cases to the tertiary centre.…”

“…In the same systematic review the cause for hysterectomy was placental pathology in 38%, uterine atony in 27% and uterine rupture in 26%. (11) In this study fourteen cases (77.78%) of obstetric hysterectomy were done for MAPP whereas only four (28.57%) were for atonic or traumatic pph. There was a single maternal mortality due to obstetric haemorrhage in this study.…”

Re: Serious maternal complications in relation to severe pre‐eclampsia: a retrospective cohort study of the impact of hospital volume; Severe maternal morbidity requires regionalisation of obstetric critical care; Guilt, blame and litigation: can an overenthusiastic ‘safety culture’ cause harm?

“…The abnormally invasive placenta (AIP), which usually requires a difficult caesarean hysterectomy, illustrates this point. The maternal mortality associated with emergent peripartum hysterectomy is reportedly 5.2%, although this refers to emergent surgery. AIP surgery, regardless of whether it is emergent or planned, can cause maternal death, which patients and society do not recognise.…”