Factors affecting postpartum hysterectomy: study in Chonprathan Hospital

Abstract

The aim of this study was to evaluate the prevalence and risk factors of emergency peripartum hysterectomy. A case-control study was conducted in the pregnant women who delivered at Chonprathan Hospital during January 2007 - December 2012. The study cases referred to pregnant women withgestational age more than 28 weeks who underwent emergency postpartum hysterectomy following cesarean or vaginal delivery. The control cases referred to pregnant women who delivered before and after the study cases were ratio 1:4. The medical records were collected and data were analyzed.Multivariate logistic regression analysis was used to identify independent risk factors with 95% confidence intervals (95% CI). During the study period, there were 26 cases of emergency peripartum hysterectomy (1.88:1,000 deliveries). In the completed data 26 cases, the main indications for surgery were postpartum hemorrhage with uterine atony (50.0%), placental factors (27.0%), and hematoma of lower uterine segment and broad ligament (23.0%). According to multivariate analysis, independent risk factors were the pregnant woman age more than 35 years (aOR=8.1, 95% CI=1.2-53.6), gravidity more than 2(aOR=3.1, 95% CI=1.1-16.9), gestational age more than 40 weeks (aOR=12.5, 95% CI=1.1-194.6), caesarean section (aOR=87.1, 95% CI=10.5-724.4) and postpartum hemorrhage (aOR=75.1, 95% CI=41.3-189.2). The prevalence of emergency peripartum hysterectomy was increasing. Women at highest risk of emergency hysterectomy were those who were more than 35 years of age, multiparous, had a caesarean delivery, or abnormal placentation, uterine atony due to postpartum hemorrhage. The medical team should assessrisks from long-term prenatal care, childbirth and the postpartum period, the sensitivity and precision in predicting the amount of blood loss after 24 hours, as well as raising awareness and understanding ofpatients and their families adequately about the risks, prevention and treatment