Emergency obstetric hysterectomy

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Abstract
A population-based review (1988–2000) of 142 634 deliveries found an incidence of emergency obstetric hysterectomy of 0.53 per 1000 deliveries. The relative risk for caesarean versus vaginal delivery was 18.32 (10.26, 32.71) P < 0.001. Previous caesarean delivery occurred in 47.4% and 22.4% were primiparous. Causes and morbidity were ascertained in a hospital-based study (1980–2001) of 64 emergency hysterectomies in 110 537 deliveries. The main indications for hysterectomy were abnormal placentation (50%) and atonic postpartum haemorrhage (32.8%). Blood transfusion was needed in 84.4% and intensive care in 26.6%. There were no maternal deaths. Potential alternatives to hysterectomy for massive obstetric haemorrhage are discussed.

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