Incidence and determinants of peripartum hysterectomy in the metropolitan area of the District of Columbia.

OBJECTIVE: To review the impact of the changes that have occurred in the standard of care in obstetrics and in the trend of cesarean delivery rates in recent times and factors associated with peripartum hysterectomy procedure.

STUDY DESIGN: A retrospective analysis of all cases of peripartum hysterectomies among inpatient hospitalizations at 4 major hospitals in the Washington metropolitan areas of the District of Columbia from January 1, 2000, through December 31, 2009, was conducted.

RESULTS: The total number of deliveries and postpartum hysterectomies that occurred at all 4 locations was 150,847 and 128, respectively. The rate of peripartum hysterectomies per 1,000 deliveries was 0.85. Primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity have direct association with peripartum hysterectomy. Up to 80% of all cases of peripartum hysterectomy are accounted for by class III and IV hemorrhage. Peripartum hysterectomy is associated with increased prevalence of uterine atony, placenta previa, and placenta accreta.

CONCLUSION: Our results suggest that primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity, uterine atony, placenta previa, and placental accreta, and class III and IV hemorrhage are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern given the increasing rate of cesarean deliveries in the District.