Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations

Abstract

BACKGROUND Postpartum hysterectomy is an obstetric procedure that carries significant maternal risk that is not well characterized by hospital volume. OBJECTIVE The objective of this study was to determine risk for peripartum hysterectomy for women at low and moderate risk for the procedure. STUDY DESIGN This population-based study used data from the Nationwide Inpatient Sample to characterize risk for peripartum hysterectomy. Women with a diagnosis of placenta accreta or prior cesarean and placenta previa were excluded. Obstetrical risk factors along with demographic and hospital factors were evaluated. Multivariable mixed-effects log-linear regression models were developed to determine adjusted risk. Based on these models receiver operating characteristic curves were plotted, and the area under the curve was determined to assess discrimination. RESULTS Cesarean hysterectomy occurred in 1 in 1913 deliveries. Risk factors associated with significant risk for hysterectomy included mode of delivery, stillbirth, placental abruption, fibroids, and antepartum hemorrhage. These factors retained their significance in adjusted models: The risk ratio for stillbirth was 3.44 (95% confidence interval (CI) 2.94–4.02), abruption 2.98 (95% CI 2.52–3.20), fibroids 3.63 (95% CI 3.22–4.08), and antepartum hemorrhage 7.15 (95% CI 6.16–8.32). The area under the curve (AUC) for the model was 0.833. CONCLUSION Cesarean hysterectomy is a relatively common event that hospitals providing routine obstetric care should be prepared to manage. That specific risk factors are highly associated with risk for hysterectomy supports routine use of hemorrhage risk-assessment tools. However, given that a significant proportion of hysterectomies will be unpredictable, the availability of rapid transfusion protocols may be necessary for hospitals to safely manage these cases.

The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications

“…a The estimated rate of peripartum hysterectomy in the present study was largely consistent with most prior work 6,7,10,31,32 but inconsistent with others. 11,[33][34][35][36] Those studies were singlesite analyses, 11,35,36 included low-risk populations, 34 or were from international cohorts. 33 The finding that rates of peripartum hysterectomy have risen agrees with previous analyses 1,7,37,38 and builds upon this prior work by evaluating recent, race-specific trends in peripartum hysterectomy.…”

Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review

“…25 Abruption was also associated with 3.5 to 31.1 times elevated risk of relaparotomy following cesarean, [26][27][28] as well as need for hysterectomy. 15,29,30 One study that did not find an association with hysterectomy may have been underpowered, as they only had two cases of abruption among the hysterectomy group, but it was unclear how many cases of abruption presented in the overall study population. 31 We classify cesarean delivery, relaparotomy, and hysterectomy as obstetric morbidities, but it is important to note that cesarean delivery is often necessary in the setting of placental abruption to limit further oxygen deprivation to the fetus; to reduce blood loss for the mother; and, in extreme cases, to prevent the death of the fetus, the mother, or both.…”

Emergency peripartum hysterectomy in a tertiary hospital in Antananarivo, Madagascar

“…5,14,19,[21][22][23] According to certain authors, cesarean sections are the source of hemorrhages. [26][27][28] In present study, the retroplacental hematoma, the case of placenta accreta, were already, themselves, risk factors for the hemorrhage of delivery.…”

“…Studies have shown that as the age increases, the risk of hemostasis hysterectomy is high. 16,26 It has been reported that multiparas were most at risk for hemostasis hysterectomy. 7,16 In the present context, it is the pauciparas and the primiparas who are the most affected.…”