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Peripartum hysterectomy for management of hemorrhage

Author
Daniela A Carusi, MD, MSc
Section Editors
Charles J Lockwood, MD, MHCM
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Peripartum hysterectomy can be defined as a hysterectomy performed at the time, or within 24 hours, of delivery. Another definition is a hysterectomy performed any time from delivery to discharge from the same hospitalization. This topic will review the surgical planning, key operative points, and postoperative care for peripartum hysterectomy.

Related topics can be found separately and include:

(See "Abdominal hysterectomy".)

(See "Overview of preoperative evaluation and preparation for gynecologic surgery".)

EPIDEMIOLOGY AND RISK FACTORS

The most recent population-level study shows a peripartum hysterectomy rate of nearly one per 1000 deliveries (eg, 0.1 percent) in the United States [1]. In addition to abnormal placentation, other significant risk factors for peripartum hysterectomy include advanced maternal age and parity, multiple gestations, antepartum bleeding, preeclampsia, bleeding disorders, and the use of assisted reproductive technologies [2-7]. While the majority of patients with these risk factors will experience neither major hemorrhage nor hysterectomy, patients who have multiple risk factors or a history of prior postpartum hemorrhage should deliver in a setting where hysterectomy is readily available if needed.

                        
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Literature review current through: Nov 2017. | This topic last updated: Nov 20, 2017.
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References
Top
  1. Govindappagari S, Wright JD, Ananth CV, et al. Risk of Peripartum Hysterectomy and Center Hysterectomy and Delivery Volume. Obstet Gynecol 2016; 128:1215.
  2. Whiteman MK, Kuklina E, Hillis SD, et al. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol 2006; 108:1486.
  3. Imudia AN, Awonuga AO, Dbouk T, et al. Incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy: a 17-year experience from a single institution. Arch Gynecol Obstet 2009; 280:619.
  4. Jakobsson M, Tapper AM, Colmorn LB, et al. Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS). Acta Obstet Gynecol Scand 2015; 94:745.
  5. Campbell SM, Corcoran P, Manning E, et al. Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland. Eur J Obstet Gynecol Reprod Biol 2016; 207:56.
  6. Friedman AM, Wright JD, Ananth CV, et al. Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations. Am J Obstet Gynecol 2016; 215:640.e1.
  7. Cromi A, Candeloro I, Marconi N, et al. Risk of peripartum hysterectomy in births after assisted reproductive technology. Fertil Steril 2016; 106:623.
  8. Glaze S, Ekwalanga P, Roberts G, et al. Peripartum hysterectomy: 1999 to 2006. Obstet Gynecol 2008; 111:732.
  9. Bodelon C, Bernabe-Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol 2009; 114:115.
  10. Rossi AC, Lee RH, Chmait RH. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol 2010; 115:637.
  11. Flood KM, Said S, Geary M, et al. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol 2009; 200:632.e1.
  12. Colmorn LB, Krebs L, Langhoff-Roos J, NOSS study group. Potentially Avoidable Peripartum Hysterectomies in Denmark: A Population Based Clinical Audit. PLoS One 2016; 11:e0161302.
  13. Hernandez JS, Nuangchamnong N, Ziadie M, et al. Placental and uterine pathology in women undergoing peripartum hysterectomy. Obstet Gynecol 2012; 119:1137.
  14. Bigelow CA, Horowitz NS, Goodman A, et al. Management and outcome of cervical cancer diagnosed in pregnancy. Am J Obstet Gynecol 2017; 216:276.e1.
  15. Knight M, UKOSS. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG 2007; 114:1380.
  16. Fitzpatrick KE, Sellers S, Spark P, et al. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 2014; 121:62.
  17. Giambattista E, Ossola MW, Duiella SF, et al. Predicting factors for emergency peripartum hysterectomy in women with placenta previa. Arch Gynecol Obstet 2012; 285:901.
  18. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177:210.
  19. Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107:1226.
  20. Knight M, Kurinczuk JJ, Spark P, et al. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 2008; 111:97.
  21. Eller AG, Bennett MA, Sharshiner M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117:331.
  22. Wright JD, Devine P, Shah M, et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol 2010; 115:1187.
  23. Imudia AN, Hobson DT, Awonuga AO, et al. Determinants and complications of emergent cesarean hysterectomy: supracervical vs total hysterectomy. Am J Obstet Gynecol 2010; 203:221.e1.
  24. Tan CH, Tay KH, Sheah K, et al. Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta. AJR Am J Roentgenol 2007; 189:1158.
  25. Shrivastava V, Nageotte M, Major C, et al. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol 2007; 197:402.e1.
  26. Ballas J, Hull AD, Saenz C, et al. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta: a management paradox. Am J Obstet Gynecol 2012; 207:216.e1.
  27. Salim R, Chulski A, Romano S, et al. Precesarean Prophylactic Balloon Catheters for Suspected Placenta Accreta: A Randomized Controlled Trial. Obstet Gynecol 2015; 126:1022.
  28. Carnevale FC, Kondo MM, de Oliveira Sousa W Jr, et al. Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta. Cardiovasc Intervent Radiol 2011; 34:758.
  29. Main EK, Goffman D, Scavone BM, et al. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage. Obstet Gynecol 2015; 126:155.
  30. Selman AE. Caesarean hysterectomy for placenta praevia/accreta using an approach via the pouch of Douglas. BJOG 2016; 123:815.
  31. Belfort MA, Shamshirsaz AA, Fox KA. A technique to positively identify the vaginal fornices during complicated postpartum hysterectomy. Am J Obstet Gynecol 2017; 217:222.e1.
  32. Milne ME, Yazer MH, Waters JH. Red blood cell salvage during obstetric hemorrhage. Obstet Gynecol 2015; 125:919.
  33. Albright CM, Rouse DJ, Werner EF. Cost savings of red cell salvage during cesarean delivery. Obstet Gynecol 2014; 124:690.
  34. Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009; 116:648.
  35. Wright JD, Bonanno C, Shah M, et al. Peripartum hysterectomy. Obstet Gynecol 2010; 116:429.
  36. Duenas-Garcia OF, Goldberg JM. Topical hemostatic agents in gynecologic surgery. Obstet Gynecol Surv 2008; 63:389.
  37. Achneck HE, Sileshi B, Jamiolkowski RM, et al. A comprehensive review of topical hemostatic agents: efficacy and recommendations for use. Ann Surg 2010; 251:217.
  38. Gabay M. Absorbable hemostatic agents. Am J Health Syst Pharm 2006; 63:1244.
  39. Berrevoet F, de Hemptinne B. Use of topical hemostatic agents during liver resection. Dig Surg 2007; 24:288.
  40. Finan MA, Fiorica JV, Hoffman MS, et al. Massive pelvic hemorrhage during gynecologic cancer surgery: "pack and go back". Gynecol Oncol 1996; 62:390.
  41. Dildy GA, Scott JR, Saffer CS, Belfort MA. An effective pressure pack for severe pelvic hemorrhage. Obstet Gynecol 2006; 108:1222.
  42. Ghourab S, Al-Nuaim L, Al-Jabari A, et al. Abdomino-pelvic packing to control severe haemorrhage following caesarean hysterectomy. J Obstet Gynaecol 1999; 19:155.
  43. Awonuga AO, Merhi ZO, Khulpateea N. Abdominal packing for intractable obstetrical and gynecologic hemorrhage. Int J Gynaecol Obstet 2006; 93:160.
  44. Howard RJ, Straughn JM Jr, Huh WK, Rouse DJ. Pelvic umbrella pack for refractory obstetric hemorrhage secondary to posterior uterine rupture. Obstet Gynecol 2002; 100:1061.
  45. Burchell RC. The umbrella pack to control pelvic hemorrhage. Conn Med 1968; 32:734.
  46. PARENTE JT, DLUGI H, WEINGOLD AB. Pelvic hemostasis: a new technic and pack. Obstet Gynecol 1962; 19:218.
  47. Cassels JW Jr, Greenberg H, Otterson WN. Pelvic tamponade in puerperal hemorrhage. A case report. J Reprod Med 1985; 30:689.
  48. Robie GF, Morgan MA, Payne GG Jr, Wasemiller-Smith L. Logothetopulos pack for the management of uncontrollable postpartum hemorrhage. Am J Perinatol 1990; 7:327.
  49. Hallak M, Dildy GA 3rd, Hurley TJ, Moise KJ Jr. Transvaginal pressure pack for life-threatening pelvic hemorrhage secondary to placenta accreta. Obstet Gynecol 1991; 78:938.
  50. Briery CM, Rose CH, Hudson WT, et al. Planned vs emergent cesarean hysterectomy. Am J Obstet Gynecol 2007; 197:154.e1.
  51. van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KW. Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol 2016; 128:1281.
  52. Shellhaas CS, Gilbert S, Landon MB, et al. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol 2009; 114:224.