Risk factors and management patterns for emergency obstetric hysterectomy over 2 decades.

OBJECTIVE: To review the demographic characteristics of patients, risk factors, indications, and complications of emergency obstetric hysterectomy (EOH), and to determine the changing trends in EOH over the last 2 decades.

METHODS: A retrospective review of all consecutive cases of EOH over the last 20 years at Mayday University Hospital, UK.

RESULTS: There were 84698 deliveries between January 1989 and January 2009. Fifty-two women had an EOH, with an incidence of 0.6 per 1000 deliveries. The underlying cause of EOH was uncontrolled primary hemorrhage in 50 (96.2%) women and severe sepsis leading to secondary hemorrhage in 2 (3.8%) women. A total of 38 (73%) EOHs were performed for intractable bleeding after cesarean delivery. Twenty-five EOHs were performed in the first decade, and 27 EOHs were performed in last decade.

CONCLUSION: Despite the introduction of pharmacologic agents and new surgical techniques to control postpartum hemorrhage, there was no reduction in the prevalence of EOH. Previous cesarean delivery with associated placenta previa or placenta accreta was a major contributor toward EOH.