Analysis of Patients Undergoing Peripartum Hysterectomy for Obstetric Causes According to Delivery Methods: 13-Year Experience of a Tertiary Center

Abstract

Objective: The aim of this study was to examine the maternal and fetal outcomes of patients undergoing peripartum hysterectomy (PH) after vaginal delivery (VD) and cesarean section (C/S). Methods: The files of patients undergoing PH following postpartum hemorrhage (PPH) between January 2005 and November 2018 were reviewed retrospectively. Patients undergoing PH were divided into two groups as C/S and VD. Age, parity, gestational weeks, time between delivery and hysterectomy, estimated blood loss, duration of operation, number of blood transfusions, hospitalization time, APGAR scores of the fetus at the 1st and 5th minutes, previous C/S histories, fetal and maternal mortality, indications for PH, additional surgeries performed during PH, and pre-op and post-op complications were recorded retrospectively and the groups were compared. Results: A total of 147 patients who underwent PH for postpartum PPH were identified. Of the patients included in the study, 77 underwent PH after VD and 70 underwent PH after C/S. There was no statistically significant difference between the groups in terms of age, parity, time between delivery and hysterectomy, estimated blood loss, number of blood transfusions, hospitalisation time, and maternal mortality rates. The gestational weeks of the patients in the VD group were higher than that of the patients in the C/S group (P = 0.003). Mean duration of operation of the C/S group was longer than that of the VD group (P ˂ 0.001). APGAR scores of the fetus at the 1st and 5th minutes were higher in the VD group compared to the C/S group (P ˂0.001, P ˂0.001, respectively). The most common indication for PH was uterine atony in the VD group (n: 54, 70.1%) and uterine rupture in the C/S group (n: 24, 34.2%). Disseminated intravascular coagulopathy (DIC) was the most common complication in both groups. Conclusion: While fetal mortality and morbidity are higher in patients undergoing hysterectomy after C/S, long-term effects caused by C/S (previous C/S, placenta accreta, placenta previa) increase PH risk. However, it should also be considered that PH risk may increase after VD as well.