Risk Factors For Peripartum Hysterectomy Research Articles

Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial

BackgroundPeripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas.MethodsWe used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis.ResultsFive percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7–3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6–5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9–1.7).ConclusionsPlacenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia.

Emergency Obstetric Hysterectomy, Risk Factors, Indications and Outcome: A Retrospective Two Year Study

Background: Obstetric emergency hysterectomy means that emergency hysterectomy which is taken after drug therapy and conservative surgery fails to control blood loss from gravid uterus. It is the last resort to save mother’s life, and beside, the mother’s reproductive capability is sacrificed. Objectives: To study the cases of peripartum hysterectomy over a period of 2 years from Jan 2015 – Dec 2016 in tertiary centre of Geetanjali Medical College and Hospital, Udaipur, to assess incidence, indication, risk factor and maternal outcome. Methods: 18 cases of emergency hysterectomies which were performed during the study period data were taken and were assessed. Results: During the study period, incidence of obstetric hysterectomy is 0.52%. Most common indication for obstetric emergency hysterectomy is atonic PPH (27.77%). Hemorrhagic shock(61.11%) is most common complication followed by bladder injury(27.11%). Conclusion: Elderly gravida with IVF pregnancy, history of previous cesarean (with adherent placenta) and history of myomectomy are risk factors for peripartum hysterectomy. These cases should be dealt cautiouly and should be handled at tertiary centres.

Risk factors of peripartum hysterectomy in placenta previa: a retrospective study of 3 840 cases

To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. The prevalence of placenta previa was 4.84%(3 840/79 304)in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76%(106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy(P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section(OR=12.9,95% CI:6.3-26.3), two or more prior cesarean sections(OR=14.4, 95%CI:3.9-53.2), anterior placenta(OR=4.8, 95%CI:2.1-10.7), complete placenta previa(OR=5.9, 95%CI: 1.8-42.5), placenta accreta(OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L(OR=1.7, 95%CI: 1.0-2.8)and delivery before 34 gestational weeks(OR=3.2, 95%CI: 1.6-6.3)were independent risk factors of peripartum hysterectomy in patients with placenta previa(P<0.05). Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.

Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study.

To estimate the incidence of emergency peripartum hysterectomy over 6 years in Ain-shams University Maternity Hospital. Detailed chart review of all cases of emergency peripartum hysterectomy, 2003-2008, including previous obstetric history, details of the index pregnancy, indications for emergency peripartum hysterectomy, outcome of the hysterectomy and infant morbidity. The overall rate of emergency peripartum hysterectomy was 149 of 66,306 or 2.24 per 1,000 deliveries. The primary indications for hysterectomies were placenta accreta/increta 59 (39.6 %), uterine atony 37 (24.8 %), uterine rupture 35 (23.5 %) and placenta previa without accreta 18 (12.1 %). After hysterectomy, 115 (77 %) women were admitted to the intensive care unit. Women were discharged home after a mean 11.2 day length of stay. Using multifactorial logistic regression analysis, we found that woman's age, atonic uterus, placenta accreta/increta, previous cesarian section and ruptured uterus were independent predictors for peripartum hysterectomy Abnormal placentation was the main indication for peripartum hysterectomy. The risk factors for peripartum hysterectomy were morbid adherence of placentae in scared uteri, uterine atony and uterine rupture. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk. The risk of peripartum hysterectomy seems to be significantly decreased by limiting the number of cesarean section deliveries, thus reducing the occurrence of abnormal placentation in the form of placenta accreta, increta or percreta.

Peripartum hysterectomy in 38 hospitals in China: a population-based study

To investigate the incidence, indications, risk factors and transfusions of peripartum hysterectomy in China. A population-based study was conducted using inpatient records of 38 hospitals between 1 January 2011 and 31 December 2011; multivariate logistic regression analysis was used to identify independent risk factors for peripartum hysterectomy. During the study period, there were 43 peripartum hysterectomy cases out of 114,420 deliveries (0.38‰). Abnormal placentation was major indication for peripartum hysterectomy. Several factors significantly increased the risk of peripartum hysterectomy in this population: placenta previa/accreta [adjusted odds ratio (aOR) 49.7, 95 % CI 25.0-98.9], maternal age ≥35 years (aOR 8.1, 95% CI 4.0-16.0), preeclampsia/eclampsia (aOR 7.5, 95% CI 2.6-21.7), cesarean delivery (aOR 3, 95% CI 1.1-8.0), and multiparity (aOR 2.7, 95% CI 1.2-5.4). In contrast, multiple gestations did not. Placenta previa/accreta, maternal age ≥35 years, preeclampsia/eclampsia, cesarean delivery and multiparity were risk factors of peripartum hysterectomy.

Risk factors for peripartum hysterectomy following uterine rupture

Objective: To investigate risk factors for hysterectomy following uterine rupture.Methods: A population-based study comparing all uterine ruptures with and without hysterectomy between 1988 and 2011 was conducted. Stratified analysis was performed using a multiple logistic regression analysis.Results: Peripartum hysterectomy complicated 20.7% (n = 34) of uterine ruptures during the study period (n = 164). Independent risk factors for hysterectomy following uterine rupture, from a multivariable logistic regression model, were relaparotomy (OR = 32.2, 95% CI = 2.5–421.9), extended tears involving the uterine cervix (OR = 6.1, 95% CI = 1.5–24.7), severe bleeding requiring packed cells transfusions (OR = 13.7, 95% CI = 3.2–58.5) and grand multiparity (≥5 deliveries, OR = 11.4 95% CI = 2.7–47.1).Conclusion: Hysterectomy is not common following uterine rupture. Independent risk factors for hysterectomy include relaparotomy, extended tears involving the uterine cervix, severe bleeding requiring packed cells transfusions and grand multiparity. Trained obstetricians should be involved in cases of uterine rupture and the possibility for conducting hysterectomy should be emphasized.

Peripartum hysterectomy between 2009 and 2010 in Sichuan, China

ObjectiveTo investigate the incidence and risk factors for peripartum hysterectomy (PH) in Sichuan, China. MethodsA population-based study was conducted using the obstetric inpatient records of women who gave birth at 1 of 8 hospitals between January 1, 2009, and December 31, 2010. Multivariate logistic regression analysis was used to identify independent risk factors for PH. ResultsDuring the study period, 64 cases of PH occurred among 34014 deliveries (0.2%); abnormal placentation and uterine atony were the major indications for surgery. Several factors significantly increased the risk of PH among the study population: placenta previa (adjusted odds ratio [AOR] 10.0; 95% confidence interval [CI], 5.7–17.7), uterine atony (AOR 7.4; 95% CI, 4.3–12.8), repeat cesarean delivery (AOR 3.0; 95% CI, 1.2–7.7), low birth weight (AOR 2.6; 95% CI, 1.5–4.6), and multiparity (AOR 2.4; 95% CI, 1.3–4.4). By contrast, multiple gestation, primary cesarean delivery, placental abruption, leiomyoma, pre-eclampsia, eclampsia, and diabetes mellitus did not significantly increase the risk of PH. ConclusionPlacenta previa, uterine atony, repeat cesarean delivery, low birth weight, and multiparity were risk factors for PH among the study population.

Measures for peripartum hysterectomy for placenta previa accreta: avoiding uterotonic agents and “double distal edge pickup” mass ligation

Many studies have been attempting in identifying the risk factors of peripartum hysterectomy. Two recent articles published in the Journal [1, 2] also targeted them; placenta previa accreta was the leading condition requiring peripartum hysterectomy [1, 2]. Identification of risk factors of peripartum hysterectomy is important since it often leads to catastrophic hemorrhage and even maternal death, thus requiring an experienced staff and multidisciplinary approach. However, as even non-experienced obstetricians must handle acute unexpected peripartum hysterectomy, ‘‘everybody manageable’’ measures are needed. In my three-decade obstetrical practice, I have devised some measures for peripartum hysterectomy, which I had described [3–5]. Briefly, the cervix should be held by forceps before surgery, which indicates the vaginal site to be transected [3, 4]. Never-slip-off mass ligation, i.e., ‘‘M cross double ligation’’ should be employed in the transection of the ovarian ligament [5]. I hope to add two more measures, which, to my knowledge, have not been described in textbook or the literature. First, in cesarean section for placenta previa, uterotonic drugs should not be administered after infant delivery. Ultrasound and/or magnetic resonance imaging may predict the presence or absence of placenta previa accreta. Identification of its risk factors [1, 2] may also be useful in predicting it. However, its presence cannot be completely excluded. If uterotonic drugs are administered in case of undiagnosed accreta, the uterus may contract and part of the placenta will separate; a partial placental separation will cause massive hemorrhage. I usually wait until spontaneous placental delivery without administering uterotonics. In many cases without accreta, the placenta is spontaneously delivered. If undelivered, I lightly pull the cord, which will help start placental delivery. If still undelivered, I employ ultrasound and identify the presence/absence of the signs of accreta. Then, the next procedure depends on the presence/absence of accreta signs, and if accreta (?) signs are present, depends on the degree and location of accreta. This measure, even in an unexpected accreta case, affords us some time to prepare hysterectomy. Administration of uterotonics, inducing partial placental separation with hemorrhage, deprives us of this time. A recent meta-analysis [6] indicated that active management of the third stage of labor, including administration of uterotonics before placental delivery, reduced the risk of hemorrhage [1,000 mL in a population of women at mixed risk of excessive bleeding; however, data focusing to patients with possible placenta accreta have been lacking. Second, hemorrhage from the incised uterine side should be prevented, which typically occurs in transection of the parametrium or paracervix. In the non-pregnant uterus, their transection usually does not require medial (uterine) side clamping: hemorrhage does not, or only seldom, even without the clamping. However, in peripartum hysterectomy, the medial (uterine) side has abundant vasculature and thus will bleed from the cutting plane. Two measures may prevent it. One method is that medial forceps should remain clamped until hysterectomy completion (Fig. 1a). However, if the uterine (or cervical) part to be transected is long, many forceps are required and remain there (Fig. 1a). This may block the operation field. Another method is to tightly ligate the medial side. Figure 1b indicates the S. Matsubara (&) Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan e-mail: matsushi@jichi.ac.jp

Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage

Objectives The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD). Study design This prospective study from 2004 to 2007 was carried out in three Dublin maternity hospitals. Women were identified as having MOH if they received ≥5 units of red cell concentrate (RCC) acutely. Risk factors for hysterectomy or end organ dysfunction were calculated using logistic regression. Results One hundred and seventeen cases of MOH in 93,291 deliveries were identified (1.25/1000). The predominant cause was uterine atony. Haemostasis was achieved with medical therapy alone in 15% of cases. The hydrostatic balloon and the B-Lynch suture arrested bleeding in 75% and 40% of cases utilised respectively. Hysterectomy was required to arrest bleeding in 24% of women and 16% of women developed end organ dysfunction (11 had both). There was one maternal death. Independent risk factors for hysterectomy included the number of previous caesarean sections (OR 3.28, 95% CI 1.95–5.5), placenta praevia (OR 13.5, 95% CI 7.7–184), placenta accreta (OR 37.7, 95% CI 7.7–184), uterine rupture (OR 7.25, 95% CI 1.25–42) and the number of units of RCC transfused (OR 1.31, 95% CI 1.13–1.5). Independent risk factors for end organ dysfunction (EOD) were placenta accreta (OR 5, 95% CI 1.5–16.5), uterine rupture (OR 13.86, 95% CI 2.32–82), the number of RCC transfused (OR 1.31, 95% CI 1.13–1.5) and the minimum haematocrit recorded (OR 5.53, 95% CI 1.7–18). Conclusions MOH is complicated by hysterectomy in 24% and end organ dysfunction in 16% of cases. The risk of peripartum hysterectomy is increased with the number of previous caesarean sections, the aetiology of the bleed, namely placenta praevia/accreta or uterine rupture and the volume of blood transfused. Critically, failure to maintain optimal haematocrit during the acute event was associated with end organ dysfunction.

Peripartum cesarean hysterectomy: critical analysis of risk factors and trends over the years

Objective. To investigate time trends and risk factors for peripartum cesarean hysterectomy.Methods. A population-based study comparing all deliveries that were complicated with peripartum hysterectomy to deliveries without this complication was conducted. Deliveries occurred during the years 1988–2007 at a tertiary medical center. A multiple logistic regression model was constructed to find independent risk factors associated with peripartum hysterectomy.Results. Emergency peripartum cesarean hysterectomy complicated 0.06% (n = 125) of all deliveries in the study period (n = 211,815). The incidence of peripartum hysterectomy increased over time (1988–1994, 0.04%; 1995–2000, 0.05%; 2001–2007, 0.095%). Independent risk factors for emergency peripratum hysterectomy from a backward, stepwise, multivariable logistic regression model were: uterine rupture (OR = 487; 95% CI 257.8–919.8, p < 0.001), placenta previa (OR = 66.4; 95% CI 39.8–111, p < 0.001), postpartum hemorrhage (PPH) (OR = 40.8; 95% CI 22.4–74.6, p < 0.001), cervical tears (OR = 22.3; 95% CI 10.4–48.1, p < 0.001), second trimester bleeding (OR = 6; 95% CI 1.8–20, p = 0.003), previous cesarean delivery (OR = 5.4; 95% CI 3.5–8.4, p < 0.001), placenta accreta (OR = 4.7; 95% CI 1.9–11.7, p = 0.001), and grand multiparity (above five deliveries, OR = 4.1; 95% CI 2.5–6.6, p < 0.001). Newborns of these women had lower Apgar scores (<7) at 1 and 5 min (32.7% vs.4.4%; p < 0.001, and 10.5% vs. 0.6%; p < 0.001, respectively), and higher rates of perinatal mortality (18.4% vs. 1.4%; p < 0.001) as compared to the comparison group.Conclusion. Significant risk factors for peripartum hysterectomy are uterine rupture, placenta previa, PPH, cervical tears, previous cesarean delivery, placenta accreta, and grand multiparity. Since the incidence rates are increasing over time, careful surveillance is warranted. Cesarean deliveries in patients with placenta previa-accreta, specifically those performed in women with a previous cesarean delivery, should involve specially trained obstetricians, following informed consent regarding the possibility of peripartum hysterectomy.

Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study

To provide an estimate of the incidence of peripartum hysterectomy in the state of New Jersey and calculate the effect of mode of delivery and prior obstetric history. A perinatal-linked dataset provided by the Maternal Child Health Epidemiology Program in the New Jersey Department of Health was used to obtain information from birth certificates and hospital discharge records. Using multivariate logistic regression, various demographic and clinical factors were assessed for association with peripartum hysterectomy. A total of 1,004,116 births were identified between 1997 and 2005 and 853 peripartum hysterectomies were performed (0.85/1,000 deliveries). Parity increased the risk of hysterectomy with nulliparous women having approximately half the risk compared to multiparous women. Cesarean delivery with no previous c-section almost doubled the risk (OR 2.20, CI 1.80-26.69) while in the presence of a previous c-section the risk was almost four times higher (OR 4.51, CI 3.76-5.40). Operative vaginal delivery did not result in any increase in the risk. Mode of delivery and prior obstetric history are major risk factors for peripartum hysterectomy. Patients desiring cesarean delivery need to be counseled on the risk of this serious complication.

Emergency peripartum hysterectomy

To determine the incidence, indications, risk factors and complications of peripartum hysterectomy in a tertiary teaching hospital. The medical records of 73 patients who had undergone emergency peripartum hysterectomy between 2003 and 2008 were reviewed retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions and maternal outcomes were evaluated. There were 73 emergency peripartum hysterectomies out of 114,720 deliveries, a rate of 0.63 per 1,000 deliveries. Eleven hysterectomies were performed after vaginal delivery (0.12/1,000 vaginal deliveries) and the remaining 62 hysterectomies were performed after cesarean section (2/1,000 cesarean sections). The most common indication for hysterectomy was placenta previa and/or accreta (31 patients, 42.4%), followed by uterine atony (26 patients, 35.6%). In this study, 22 of 29 patients (75.8%) with placenta previa and 12 of 16 patients (75%) with placenta accreta had previously had cesarean sections. Cesarean section is associated with placenta previa and accreta, which are the most common causes of emergency peripartum hysterectomy. The increase in the cesarean delivery rate is leading to an increase in the rate of abnormal placentation (placenta previa and accreta), which in turn give rise to an increase in the peripartum hysterectomy rate. Cesarean section itself is also a risk factor for emergency peripartum hysterectomy. Therefore, every effort should be made to reduce the cesarean rate by performing this procedure only for valid clinical indications. The risk factors for peripartum hysterectomy should be identified antenatally. The delivery and operation should be performed in appropriate clinical settings by experienced surgeons when risk factors are identified.

Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands

The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage. This was a 2-year prospective nationwide population-based cohort study. All pregnant women in the Netherlands during the same period acted as reference cohort (n = 371,021). We included 205 women; the overall incidence was 5.7 per 10,000 deliveries. Arterial embolization was performed in 114 women (incidence, 3.2 per 10,000; case fatality rate, 2.0%). Peripartum hysterectomy was performed in 108 women (incidence, 3.0 per 10,000; case fatality rate, 1.9%). Seventeen women underwent hysterectomy after failure of embolization. Cesarean delivery (relative risk, 6.6; 95% confidence interval, 5.0-8.7) and multiple pregnancy (relative risk, 6.6; 95% confidence interval, 4.2-10.4) were the most important risk factors in univariable analysis. The rate of obstetric hemorrhage that necessitates hysterectomy or arterial embolization in the Netherlands is 5.7 per 10,000 deliveries; fertility is preserved in 46% of women by successful arterial embolization.

Peripartum hysterectomy in Taiwan

Objective To investigate the incidence and associated risk factors for peripartum hysterectomy in singleton pregnancies. Methods A retrospective cohort study of all women with singleton pregnancies admitted for delivery in 2002 taken from the National Healthcare Insurance database. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for maternal and hospital characteristics using logistic regression. Results There were 287 peripartum hysterectomies in 214 237 singleton pregnancies (0.13%). Cesarean delivery, vaginal birth after cesarean (VBAC), and repeat cesarean delivery had higher hysterectomy rates than vaginal delivery, with adjusted ORs of 12.13 (95% CI 8.30–17.74), 5.12 (95% CI 1.19–21.92), and 3.84 (95% CI 2.52–5.86), respectively. Pregnancies complicated with placenta previa, gestational diabetes mellitus (GDM), and premature labor were associated with significantly increased risks for peripartum hysterectomy ( P < 0.05). Conclusion Risk factors for peripartum hysterectomy included cesarean delivery, VBAC, repeat cesarean, placenta previa, GDM, and premature labor. VBAC and repeat cesarean had a similar risk.

Cesarean Delivery and Peripartum Hysterectomy

To estimate the national incidence of peripartum hysterectomy and quantify the risk associated with cesarean deliveries and other factors. A population-based, matched case-control study using the United Kingdom Obstetric Surveillance System, including 318 women in the United Kingdom who underwent peripartum hysterectomy between February 2005 and February 2006 and 614 matched control women. The incidence of peripartum hysterectomy was 4.1 cases per 10,000 births (95% confidence interval [CI] 3.6-4.5). Maternal mortality was 0.6% (95% CI 0-1.5%). Previous cesarean delivery (odds ratio [OR] 3.52, 95% CI 2.35-5.26), maternal age over 35 years (OR 2.42, 95% CI 1.66-3.58), parity of three or greater (OR 2.30, 95% CI 1.26-4.18), previous manual placental removal (OR 12.5, 95% CI 1.17-133.0), previous myomectomy (OR 14.0, 95% CI 1.31-149.3), and twin pregnancy (OR 6.30, 95% CI 1.73-23.0) were all risk factors for peripartum hysterectomy. The risk associated with previous cesarean delivery was higher with increasing numbers of previous cesarean deliveries (OR 2.14 with one previous delivery [95% CI 1.37-3.33], 18.6 with two or more [95% CI 7.67-45.4]). Women undergoing a first cesarean delivery in the current pregnancy were also at increased risk (OR 7.13, 95% CI 3.71-13.7). Peripartum hysterectomy is strongly associated with previous cesarean delivery, and the risk rises with increasing number of previous cesarean deliveries, maternal age over 35 years, and parity greater than 3. II.

Antepartum Risk Factors Associated with Peripartum Cesarean Hysterectomy in Women with Placenta Previa

The objective of this study was to identify antepartum risk factors for peripartum hysterectomy in women with placenta previa. The medical records of women with placenta previa who underwent cesarean section (C/S) were reviewed retrospectively. Data regarding the reproductive history and peripartum outcomes were analyzed. Multivariable analysis was used to identify factors independently associated with hysterectomy. During an 8.5-year period, 346 cases of placenta previa were identified in 24,987 deliveries (1.4%). An emergent hysterectomy was performed in 31 patients (9.0%). Multiparity, total previa, history of abortion, C/S, and placenta previa was more common in the hysterectomy group. An increasing number of abortions and C/S were associated with a higher frequency of hysterectomy. By the multivariable analysis, previous abortion, previous C/S, and total previa were significant risk factors for hysterectomy. We concluded that in women with placenta previa, history of abortion as well as prior C/S, and a total previa are strong antepartum risk factors for peripartum hysterectomy.