RESULTS
There were 34020 deliveries during the study period. A total of 66
peripartum hysterectomies were performed with an incidence of 1.9 per
1000 deliveries. We analyzed 66 patients who underwent peripartum
hysterectomy. Mean age of patients was 31.3±5.5 years. The gravidity
ranged between 1 and 12 with a mean of 3.9±2.4. The average gestational
age was 35.7±3.7 weeks. Of these 66, 14(21.2%) women delivered
vaginally and 52(78.8%) women had cesarean section. Half of the
patients(n=33) had at least one previous cesarean section. The most
common indications for overall study population was placenta
accreata(n=26, 39.4%) and the second one was uterine atony(n=20,
30.3%). Twenty-four(36.4%) patients had subtotal abdominal
hsyterectomy and in 42 patients(63.6%), total abdominal hysterectomy
was performed. We scheduled planned hysterectomy in 31(47%) patients,
while emergent hysterectomy was performed in 35(53%) cases. Table 1
summarizes the demographic and clinical parameters of emergent and
planned surgery groups. The mean gestational age was significantly lower
in the planned hysterectomy group(p=0.002). Moreover, more than 90% of
the patients in the planned group delivered after 34 gestational weeks.
We showed the indications of hysterectomy for study groups(Table 2). The
uterine atony was the most common indication in the emergent group,
whereas abnormal placentation was the most common indication in the
planned group(57.1% and 67.7% , respectively). We compared the blood
transfusions, postoperative laboratory values and intraoperative
complications between the emergent and planned hysterectomy groups(Table
3). The planned hysterectomy group was required significantly lower
blood products in the intra- and post-operative period. The
postoperative Hb and the differences of pre- and post-operative Hb
values were also significantly different among study groups. The
complication rates were similar for emergent and planned surgery groups.
The duration of hospital stay was lower in the planned surgery but it
did not reach any statistical significance. Table 4 presented that the
neonatal outcomes were significantly different between emergent and
planned hysterectomy groups. The mean birth weight was significantly
lower in the planned group, it might be related to the lower gestational
weeks on the surgery time. Although we have demonstrated the lower birth
weight in the planned group, the apgar scores were significantly better
than the emergent hysterectomy group(p<0.01).