Incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy: a 17-year experience from a single institution.

PURPOSE: To review the incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy (CH) in our institution.

MATERIALS AND METHODS: Retrospective study of 158 women who had CH at the Detroit Medical Center during a 17 period.

RESULTS: During the study period, 158 of 202,356 deliveries were CH, giving an overall incidence of 0.78 per 1,000 deliveries. Of the 158 cases, 14 were elective while 144 were emergently performed due to complications encountered at cesarean section. Analysis of the eligible 144 cases showed that the commonest risk factors were previous cesarean delivery (76%) and placenta previa (35%). Abnormal placenta adherence was the indication for CH in 50.7%, followed by uterine atony in 34.7% and uterine rupture in 16.7% of the cases. Febrile morbidity (44.4%) and disseminated intravascular coagulopathy (22.9%) were the most common postoperative complications. Most complications occurred in patients with parity greater than two. Compared to the last decade, CH performed more recently were less likely to be complicated by bowel injury or disseminated intravascular coagulopathy.

CONCLUSION: Morbidly adherent placenta has replaced uterine atony as the leading indication for emergent CH in our institution. High parity remains a risk factor for complications; however, we recorded a reduction in bowel injury and disseminated intravascular coagulopathy in recent years.