Objective
The purpose of this study was to identify changing trends in peripartum hysterectomy
(PH) in a single large obstetric population over the last 40 years.
Study Design
A retrospective cohort study was performed from 1966-2005 of patients who had PH in
any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained
from the combined patient databases of each hospital.
Results
There were 872,379 deliveries during the study period, among which 358 women underwent
PH (0.4/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005,
PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the
overall cesarean delivery rate has increased from 6-19% during these 2 decades, the
percentage of PH that occurs in the setting of a previous cesarean delivery has increased
from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with
“uterine rupture” as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5%
(P < .00001).
Conclusion
PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery
rate, there has been a marked increase in the incidence of placenta accreta.
Key words
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Article info
Publication history
Published online: March 23, 2009
Accepted:
February 11,
2009
Received:
August 1,
2008
Footnotes
Cite this article as: Flood KM, Said S, Geary M, et al. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol 2009;200:632.e1-632.e6.
Authorship and contribution to the manuscript is limited to the 6 authors indicated. There was no outside funding or technical assistance with the production of this article.
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
