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Cesarean Delivery and Peripartum Hysterectomy

Knight, Marian MBChB, DPhil; Kurinczuk, Jennifer J. MSc, MD; Spark, Patsy BSc; Brocklehurst, Peter MBChB, MSc

doi: 10.1097/01.AOG.0000296658.83240.6d
Original Research

OBJECTIVE: To estimate the national incidence of peripartum hysterectomy and quantify the risk associated with cesarean deliveries and other factors.

METHODS: A population-based, matched case-control study using the United Kingdom Obstetric Surveillance System, including 318 women in the United Kingdom who underwent peripartum hysterectomy between February 2005 and February 2006 and 614 matched control women.

RESULTS: The incidence of peripartum hysterectomy was 4.1 cases per 10,000 births (95% confidence interval [CI] 3.6–4.5). Maternal mortality was 0.6% (95% CI 0–1.5%). Previous cesarean delivery (odds ratio [OR] 3.52, 95% CI 2.35–5.26), maternal age over 35 years (OR 2.42, 95% CI 1.66–3.58), parity of three or greater (OR 2.30, 95% CI 1.26–4.18), previous manual placental removal (OR 12.5, 95% CI 1.17–133.0), previous myomectomy (OR 14.0, 95% CI 1.31–149.3), and twin pregnancy (OR 6.30, 95% CI 1.73–23.0) were all risk factors for peripartum hysterectomy. The risk associated with previous cesarean delivery was higher with increasing numbers of previous cesarean deliveries (OR 2.14 with one previous delivery [95% CI 1.37–3.33], 18.6 with two or more [95% CI 7.67–45.4]). Women undergoing a first cesarean delivery in the current pregnancy were also at increased risk (OR 7.13, 95% CI 3.71–13.7).

CONCLUSION: Peripartum hysterectomy is strongly associated with previous cesarean delivery, and the risk rises with increasing number of previous cesarean deliveries, maternal age over 35 years, and parity greater than 3.

LEVEL OF EVIDENCE: II

Peripartum hysterectomy is strongly associated with previous cesarean delivery, and the risk rises with an increasing number of previous cesarean deliveries. Supplemental Digital Content is Available in the Text.

From the National Perinatal Epidemiology Unit, University of Oxford, United Kingdom.

*For members of United Kingdom Obstetric Surveillance System Steering Committee, see the Appendix online at www.greenjournal.org/cgi/content/full/111/1/97/DC1.

Dr. Knight is funded by the Oxford Deanery public health training program and the National Coordinating Centre for Research Capacity Development of the Department of Health. Dr. Kurinczuk was partially funded by a National Public Health Career Scientist Award from the Department of Health and the National Health Service Research and Development (PHCS 022). The National Perinatal Epidemiology Unit is funded by a grant from the Department of Health in England. The views expressed in this article are those of the authors and do not necessarily reflect the views of the Department of Health.

The authors thank the United Kingdom Obstetric Surveillance System (UKOSS) reporting clinicians who notified cases and completed the data collection forms. The authors also acknowledge the assistance of the UKOSS Steering Committee and the support of the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, Obstetric Anesthetists Association, Faculty of Public Health, National Childbirth Trust, and the Confidential Enquiry into Maternal and Child Health.

Presented as an oral free communication at the British International Congress of Obstetrics and Gynecology, London, July 4–6, 2007.

Corresponding author: Marian Knight, Senior Clinical Research Fellow, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Oxford, UK; e-mail: marian.knight@npeu.ox.ac.uk.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.