Epidemiological analysis of peripartum hysterectomy across nine European countries
Open Access
- 2 May 2020
- journal article
- research article
- Published by Wiley in Acta Obstetricia et Gynecologica Scandinavica
- Vol. 99 (10), 1364-1373
- https://doi.org/10.1111/aogs.13892
Abstract
Introduction Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high‐resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries. Material and methods We performed a descriptive, multinational, population‐based study among women who underwent peripartum hysterectomy. Data were collected from national or multi‐regional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48 hours postpartum due to obstetric hemorrhage, since this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section. Results 1,302 peripartum hysterectomies were performed in 2,498,013 births leading to a prevalence of 5.2 per 10,000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared to vaginal birth was 9.1 (95% confidence interval [CI] 8.0‐10.4). Relative risk for hysterectomy for birth after previous cesarean section compared to birth without previous cesarean section was 10.6 (95% CI 9.4‐12.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (ρ=0.67, p<0.05). Conclusions Prevalence of peripartum hysterectomy may vary considerably between high income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine‐fold increased risk of peripartum hysterectomy.Keywords
This publication has 25 references indexed in Scilit:
- The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at deliveryActa Obstetricia et Gynecologica Scandinavica, 2015
- The International Network of Obstetric Survey Systems (INOSS): benefits of multi‐country studies of severe and uncommon maternal morbiditiesActa Obstetricia et Gynecologica Scandinavica, 2013
- Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the NetherlandsAmerican Journal of Obstetrics and Gynecology, 2010
- Changing trends in peripartum hysterectomy over the last 4 decadesAmerican Journal of Obstetrics and Gynecology, 2009
- Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population‐based study of 371 000 pregnanciesBJOG: An International Journal of Obstetrics and Gynaecology, 2008
- Peripartum hysterectomy in Denmark 1995–2004Acta Obstetricia et Gynecologica Scandinavica, 2007
- Incidence and Determinants of Peripartum HysterectomyObstetrics & Gynecology, 2006
- Maternal Morbidity Associated With Multiple Repeat Cesarean DeliveriesObstetrics & Gynecology, 2006
- Emergency peripartum hysterectomy: A prospective study in The NetherlandsEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2006
- The UK Obstetric Surveillance System for raredisorders of pregnancyBJOG: An International Journal of Obstetrics and Gynaecology, 2005