Peripartum Hysterectomies over a Fifteen-year Period

To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure.

Methods

A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019.

Results

The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, andwefound no differencebetween total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age.

Conclusion

Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.

Keywords:
puerperal hysterectomy; postpartum hemorrhage; placenta accreta; placenta previa

Maternal characteristics and previous and current pregnancy complications	n	Mean (standard deviation) or % (n)
Maternal age (years)	47	31.2 (6.3)
Previous cesarean section	47	59.6% (28)
Maternal weight (kg)	46	81.1 (16.3)
Maternal Body Mass Index (kg/m²)	46	30.9 (6.0)
History of previous postpartum hemorrhage	47	8.5% (4)
Placenta previa in the current pregnancy	47	27.7% (13)
Placenta accreta in the current pregnancy	47	42.6% (20)
Preterm labor in the current pregnancy	47	19.1% (9)
Prelabor rupture of membranes in the current pregnancy	47	10.6% (5)
Cephalopelvic disproportion in the current pregnancy	47	8.5% (4)
Postpartum hemorrhage in the current pregnancy	47	55.3% (26)
Intrauterine infection and/or puerperal infection	47	44.7% (21)
Urinary tract infection in the current pregnancy	47	29.8% (14)

Indications for Cesarean delivery and for peripartum hysterectomy and maternal and fetal outcomes	n	Mean (standard deviation) or % (n)
Cesarean delivery in the current pregnancy	47	74.5% (35)
Indication for cesarean delivery
Placenta previa	35	37.1% (13)
Fetal distress	35	17.1% (6)
Cephalopelvic disproportion	35	11.4% (4)
Placenta accreta or suspicion thereof with no placenta previa	35	11.4% (4)
Cause of peripartum hysterectomy
Placenta accreta or suspicion thereof	47	44.7% (21)
Postpartum hemorrhage with no placenta accreta nor suspicion thereof	47	27.7% (13)
Puerperal infection and suspicion thereof	47	25.5% (12)
Uterine rupture	47	2.1% (1)
Total hysterectomy	47	63.8% (30)
Hysterectomy within 24 hours after delivery	47	66.0% (31)
Antibiotic therapy during delivery or hysterectomy hospitalizations or in the postpartum period	47	59.6% (28)
Transfusion of red blood cells	47	76.6% (36)
Intensive care admission	47	66.0% (31)
Gestational age at delivery (weeks)	47	37.2 (3.2)
Male newborn	45	35.6% (16)
Birth weight (kg)	45	2.876 (0.686)

	Hysterectomy after 24h after delivery		Hysterectomy within 24h after delivery		p-value
	n	Mean (standard deviation) or % (n)	n	Mean (standard deviation) or % (n)	p-value
Previous Cesarean section	16	43.8% (7)	31	67.7% (21)	0.131
History of previous postpartum hemorrhage	16	0% (0)	31	12.9% (4)	0.284
Placenta previa	16	6.3% (1)	31	38.7% (12)	0.036
Placenta accreta	16	18.8% (3)	31	54.8% (17)	0.029
Prelabor rupture of membranes	16	25.0% (4)	31	3.2% (1)	0.040
Preterm labor	16	31.3% (5)	31	12.9% (4)	0.239
Cephalopelvic disproportion	16	12.5% (2)	31	6.5% (2)	0.597
Maternal age (years)	16	27.1 (6.6)	31	33.3 (5.1)	0.001
Maternal Body Mass Index (kg/m²)	15	30.5 (6.2)	31	31.1 (6.0)	0.742
Gestational age at delivery (weeks)	16	37.3 (3.7)	31	37.1 (3.0)	0.835
Birth weight (kg)	14	3.068 (0.768)	31	2.790 (0.640)	0.212

	NO ICU ADMISSION		ICU ADMISSION		p-value
	n	Mean (standard deviation) or % (n)	n	Mean (standard deviation) or % (n)	p-value
Previous Cesarean section	16	87.5% (14)	31	45.2% (14)	0.006
History of previous postpartum hemorrhage	16	12.5% (2)	31	6.5% (2)	0.597
Placenta previa	16	50.0% (8)	31	16.1% (5)	0.020
Placenta accreta	16	62.5% (10)	31	32.3% (10)	0.065
Prelabor rupture of membranes	16	12.5% (2)	31	9.7% (3)	1.000
Preterm labor	16	18.8% (3)	31	19.4% (6)	1.000
Cephalopelvic disproportion	16	0% (0)	31	12.9% (4)	0.284
Maternal age (years)	16	33.3 (3.5)	31	30.1 (7.2)	0.045
Maternal Body Mass Index (kg/m²)	16	30.8 (6.9)	30	31.0 (5.6)	0.894
Gestational age at delivery (weeks)	16	36.8 (2.5)	31	37.4 (3.6)	0.595
Birth weight (kg)	16	2.650 (0.493)	29	3.001 (0.751)	0.101

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[1] Address for correspondence José Geraldo Lopes Ramos, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Escritório 1125, Porto Alegre, RS, 90035-903, Brazil (e-mail: jramos@hcpa.edu.br).