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Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review

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Abstract

Introduction

Our objective was to determine the incidence and mortality rates associated with emergency peripartum hysterectomy, factors that lead to uncontrolled hemorrhage and emergency peripartum hysterectomy, and to determine the relationship between cesarean section and risk of emergency peripartum hysterectomy.

Materials and methods

Studies published between January 1, 2000 and December 31, 2012 were identified using PubMed, OVID and Web of Science databases. Studies were included if they reported incidence rates for emergency peripartum hysterectomy, factors that lead to hemorrhage and emergency peripartum hysterectomy, or the association of emergency peripartum hysterectomy with cesarean section in high-income countries.

Results

Four hundred and fifty-one studies were identified, and 52 were included. The incidence of emergency peripartum hysterectomy ranged from 0.20 to 5.09 per 1000 deliveries with a median incidence rate of 0.61 per 1000 deliveries. These rates have increased over time. Rates varied by region/country, specifically with the United States reporting higher rates than North American, Asian, Oceania, and European countries. The most common factor leading to emergency peripartum hysterectomy was placental abnormalities. Both cesarean section and prior cesarean section were strong risk factors for emergency peripartum hysterectomy with higher risks conferred for each additional cesarean section. The mean percentage of maternal deaths for EPH survivors was 3.0 %.

Conclusion

Given the association of cesarean section with emergency peripartum hysterectomy, the increased risk of emergency peripartum hysterectomy should be factored into the decision of whether to proceed with cesarean delivery, particularly for women who desire more children.

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Acknowledgments

The authors would like to thank Charles Mahan, MD, Professor Emeritus, in the Department of Community and Family Health, College of Public Health, at the University of South Florida in Tampa, FL, for his review of this manuscript.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA

    Cara Z. de la Cruz & Erika L. Thompson

  2. Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, 33612, USA

    Kathleen O’Rourke & Wendy N. Nembhard

Authors
  1. Cara Z. de la Cruz
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  2. Erika L. Thompson
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Correspondence to Cara Z. de la Cruz.

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de la Cruz, C.Z., Thompson, E.L., O’Rourke, K. et al. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review. Arch Gynecol Obstet 292, 1201–1215 (2015). https://doi.org/10.1007/s00404-015-3790-2

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