Emergency peripartum hysterectomy in a tertiary Istanbul hospital

Objective To evaluate the incidence, risk factors, indications, outcomes and complications of emergency peripartum hysterectomy performed after cesarean and vaginal deliveries. Method(s) We analyzed retrospectively 28 cases of emergency peripartum hysterectomy operations performed between February 2001 and February 2007 at the Istanbul Goztepe Training and Research Hospital, which is a teaching hospital operating under the Turkish Ministry of Health. The indications, risk factors and the associated complications were compared with control groups. Statistical analysis was performed using the STATA version 7.0 statistical package (Stata Corporation, College Station, TX, USA). Result(s) The overall incidence of emergency peripartum hysterectomy at our hospital is 0,37 in 1,000 deliveries. Abnormal placental adherence and uterine atony comprised 85% of the indications for peripartum hysterectomy. Postoperative maternal morbidity occurred in 15 cases (54%). Most had a febrile morbidity and depression. Seven patients underwent postpartum histerectomy due to consumptive coagulopathy. There was one maternal mortality (4%) and five perinatal mortalities (18%). The maternal death was due to consumptive coagulopathy after placental abruption. All patients had to receive blood transfusions. The median number of postoperative hospitalization days was 7. Conclusion(s) Peripartum hysterectomy is still a dramatic life-saving operation with high risks. The most common reason for abnormal placental adherence is previous uterine procedures.