Anesthetic review of emergency peripartum hysterectomy following vaginal and cesarean delivery: a retrospective study

BACKGROUND The purpose of this study was to review incidence, indications, complications, and the anesthetic management of emergency obstetric hysterectomies. METHODS This was a retrospective study of the cases of emergency obstetric hysterectomies performed at the Woman's Hospital over a 3 year period between January 2008 and December 2010. The indication for surgery, anesthetic management, operating time, estimated blood loss, pre- and postoperative hemoglobin and hematocrit values, need for blood transfusion, and perioperative complications were obtained. RESULTS During the study period there were 46 emergency obstetric hysterectomies for 20147 deliveries, giving an incidence of 2.28/1000 deliveries. The number of emergency hysterectomies was significantly higher with the cesarean deliveries than with the vaginal deliveries. The most common indication for emergency obstetric hysterectomy was placenta accreta. Postoperatively, Dissemimated Intravascular Coagulation (DIC) was the most common complication. CONCLUSIONS Abnormal placenta has been an main indication of emergency hysterectomy. Anesthesiologists should be eligible to aware of high risk of emergency hysterectomy and deal with massive hemorrhage.