Risk factors for emergency postpartum hysterectomy : the neglected role of previous surgically induced abortions

The objective of this retrospective case-control study was to identify clinical factors associated with emergency peripartum hysterectomy. Deliveries from January 2003 through October 2009 in this tertiary care obstetrics hospital were reviewed. Cases were women who underwent emergency peripartum hysterectomy. Controls were those who delivered immediately after the cases but in whom hysterectomy was not needed. They were matched to cases in a 5:1 ratio. Thirty-eight cases and 190 controls were selected. Variables found to be significantly associated with emergency postpartum hysterectomy were a stage III-IV placenta previa (p<0.001), previous surgical abortions (p=0.001) and number of fetuses (p=0.039). The corresponding adjusted odds ratios were 40.2 (95% confidence interval 5.6-287.0), 6.0 (95% confidence interval 2.1-17.2) and 7.8 (95% confidence interval 1.1-55.0), respectively. The study confirms the detrimental role of major placenta previa in influencing the risk of postpartum hysterectomy, but also suggests multiple pregnancy and surgical abortion as potential additional risk factors.