Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands.

OBJECTIVE: The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage.

STUDY DESIGN: This was a 2-year prospective nationwide population-based cohort study. All pregnant women in the Netherlands during the same period acted as reference cohort (n = 371,021).

RESULTS: We included 205 women; the overall incidence was 5.7 per 10,000 deliveries. Arterial embolization was performed in 114 women (incidence, 3.2 per 10,000; case fatality rate, 2.0%). Peripartum hysterectomy was performed in 108 women (incidence, 3.0 per 10,000; case fatality rate, 1.9%). Seventeen women underwent hysterectomy after failure of embolization. Cesarean delivery (relative risk, 6.6; 95% confidence interval, 5.0-8.7) and multiple pregnancy (relative risk, 6.6; 95% confidence interval, 4.2-10.4) were the most important risk factors in univariable analysis.

CONCLUSION: The rate of obstetric hemorrhage that necessitates hysterectomy or arterial embolization in the Netherlands is 5.7 per 10,000 deliveries; fertility is preserved in 46% of women by successful arterial embolization.