EMERGENCY HYSTERECTOMY FOR OBSTETRIC HEMORRHAGE

  • 1 January 1984
    • journal article
    • research article
    • Vol. 64  (3) , 376-380
Abstract
From 1978 to 1982, 70 cases of emergency hysterectomy for obstetric hemorrhage were performed at Los Angeles County/University of Southern California Women''s Hospital [Los Angeles, California, USA]. Hysterectomies (60) followed cesarean section, and 10 were performed for hemorrhage after vaginal delivery. The most common indication for hysterectomy was atony (43%) followed by placental accreta (30%), uterine rupture (13%), extension of a low transverse incision (10%) and leiomyomata preventing uterine closure and hemostasis (4%). Hysterectomies performed for atony had a significant association with the following factors when compared to hysterectomies performed for other indications: amnionitis, cesarean section for labor arrest, oxytocin augmentation of labor, MgSO4 infusion and fetal weight. Of hysterectomies performed for placenta accreta, 57% were associated with a previous cesarean section. During the study period, 53% of all patients presenting at term with both a placenta previa and one or more previous cesarean sections, subsequently underwent hysterectomy for placenta accreta. Even with a broad inclusion of risk factors, only 74% of patients developing a hemorrhagic complication leading to hysterectomy can be identified before delivery.

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