16 - Emergency obstetric hysterectomy

Summary

Emergency postpartum hysterectomy is one of the most commonly accepted markers of severe maternal morbidity. The incidence varies from about 1/350 to 1/7000 deliveries and the maternal mortality rate ranges from 0% to 35%. The higher incidence and mortality rates are found in regions with limited hospital resources. In developed countries the incidence of emergency obstetric hysterectomy is about 1/2000– 3000. There is an association between emergency hysterectomy and caesarean section and between emergency hysterectomy and multiple pregnancy. With increasing rates of caesarean delivery and with assisted reproductive techniques producing more multiple pregnancies, the need for obstetric hysterectomy is increasing in some countries. For example, in Canada between 1991 and 2003 the obstetric hysterectomy rate rose significantly from 0.26/1000 deliveries to 0.46/1000 deliveries.

Indications

The three main conditions leading to obstetric hysterectomy are abnormal placentation, uterine atony and uterine rupture and trauma.

ABNORMAL PLACENTATION: PLACENTA PRAEVIA AND/OR ACCRETA

The rising incidence of delivery by caesarean section has been accompanied by an increased risk of placenta praevia and/or accreta in subsequent pregnancies, making these the most common reasons for obstetric hysterectomy in developed countries.