Journal Article

Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial

Huque, Sumaya, Shakur-Still, Haleema, Chaudhri, Rizwana, Arulkumaran, Sabaratnam, Fawole, Bukola, Roberts, Ian

2018

Overview

Background Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. Methods We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. Results Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7–3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6–5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9–1.7). Conclusions Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Adult / Africa / Africa - epidemiology / Age / Antifibrinolytic agents / Asia / Asia - epidemiology / Blood pressure / Caesarean section / Cesarean section / Cesarean Section - adverse effects / Cohort Studies / delivery / Delivery, Obstetric - adverse effects / Europe - epidemiology / Female / Gynecology / Health risk assessment / Hemorrhage / Humans / Hysterectomy / Hysterectomy - statistics & numerical data / Incidence / Labor / Maternal and Child Health / Medicine / Medicine & Public Health / Mortality / Obstetrics / Odds Ratio / Peripartum hysterectomy / Peripartum Period / Placenta / Placenta accreta / Placenta Accreta - surgery / Placenta Previa - surgery / Postpartum haemorrhage / postpartum health / Postpartum Hemorrhage - etiology / Postpartum Hemorrhage - surgery / Postpartum period / Pregnancy / Quantitative analysis / Reproductive Medicine / Research Article / Risk Factors / Uterine Inertia - surgery / Womens health