Peripartum Hysterectomy: 10-Year Experience in Two Manitoba Tertiary Centers

Abstract

The aim of the study was to review the incidence, associated risk factors, indications and complications of peripartum hysterectomy in the two teaching hospitals of the University of Manitoba, Canada. We conducted a retrospective study of all cases of peripartum hysterectomy that occurred over a 10-year period at the Health Sciences Centre (HSC), and over a five-year period at St. Boniface General Hospital (SBGH), the two tertiary centers in Winnipeg, Manitoba. Twenty-five peripartum hysterectomies were identified among 59,839 deliveries at both HSC and SBGH, for an overall incidence of 0.4/1000 births. Twenty-three hysterectomies (92%) were performed as emergency procedures, 19 (76%) followed a cesarean section (relative risk = 15), and 15 patients had single or multiple prior cesarean section scars (relative risk = 14.2). The indications for hysterectomy were: hemorrhage due to placenta/accreta (n=9); uterine atony (n=6); uterine rupture (n=5); retroperitoneal hematoma (n=2); and cervical laceration (n=1). Two cases were performed electively for cervical and ovarian cancer, respectively. Twenty-three women (92%) required blood transfusion, five (20%) had coagulopathy, four (16%) had bladder injuries, and three (12%) required salpingo-oophorectomy for uncontrolled adnexal bleeding. Our reported incidence for peripartum hysterectomy is lower than that reported elsewhere in the recent literature, while the risk factors for hysterectomy were similar to those reported. Although the maternal mortality was nil in this study, morbidity was high.