Frequency and causes of emergency hysterectomy along with vaginal delivery and caesarean section in Hamadan, Iran

BACKGROUND Emergency hysterectomy (peripartum) is a high-risk surgery that almost always is done in the treatment or prevention of severe and life-threatening bleeding that occurs after vaginal delivery or caesarean. OBJECTIVE To compare the frequency and causes of emergency hysterectomy along with the vaginal delivery and caesarean section (CS). METHODS The cross-sectional research was conducted on patients who underwent a peripartum hysterectomy from 2005 to 2015 at Fatemieh Hospital in Hamadan City, Iran. Data collection tools included a questionnaire about demographic features and factors associated with hysterectomy surgery. Data were analyzed using SPSS version 21 and by descriptive statistics, chi-square, paired t-test, and one-way analysis of variance (ANOVA). RESULTS The mean age of women was 33.4±5.09 years. In recent years, 37 cases of hysterectomy were reported, with the peak occurring in 2015. The highest prevalence of hysterectomy was associated with 28 (77.8%) women with a third pregnancy and second parity, while 32 cases (86.5) were related to those with no history of vaginal delivery, 15 (45.5%) were related to repeated CS and second repeated CS; 28 cases (75.7%) to those with no history of placenta previa; 21 cases (56.8) to the majority with the anterior placenta;, 33 cases (97.1%) to those with no over-distance of uterine; and 36 cases (97.3%) to those without a history of uterine myoma. Among 37 cases who had hysterectomy, placenta accreta was observed in 27 cases (77.1%), with placenta increta in three (8.1%) and placental attachment, including percreta, were seen in seven cases (18.9 %). CONCLUSION The rate of hysterectomy in multiparous women (in their third or fourth pregnancy) was higher. The greatest cause of hysterectomy was related to attached placenta including accreta, uterus atony, a history of CS, multipara, and repeated CS. Therefore, due to the increase in the number of CSs in recent years, planning should be taken into account in order to encourage pregnant women for vaginal delivery.