Risk Factors for Cesarean Hysterectomy in Cesarean Delivery
Naratorn Watanasomsiri MD*, Tassawan Rungruxsirivorn MD*, Surasith Chaithongwongwatthana MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University
Objective : To identify the risk factors for cesarean hysterectomy.
Materials and Methods : A case-control study was conducted by reviewing the medical records of pregnant
women delivered in King Chulalongkorn Memorial Hospital between January 1994 and December 2004.
Cases included pregnant women who underwent hysterectomy immediately or within 24 hours after cesarean
delivery, whereas control referred to pregnant women who underwent cesarean section at the same period.
Results : Of the 109,005 deliveries, twenty-seven women (0.25/1000-delivery) underwent cesarean hysterec-
tomy. With multivariate analysis, the risk factors significantly associated with peripartum hysterectomy were
placenta previa (adjusted OR = 67.96, 95%CI = 15.32, 301.46) and multiparity (adjusted OR = 7.30, 95%CI
= 1.24, 43.19). When compared to controls, cases with cesarean hysterectomy had higher incidence of mater-
nal and neonatal morbidities, needed more blood transfusion and required longer hospital stays. Operation
performed in daytime found to have less mean blood loss (1,766 ml) compared to operation at nighttime
(5,730 ml).
Conclusions : Placenta previa and multiparity were significant risk factors of cesarean hysterectomy. Cesar-
ean section in these cases should be done by experienced obstetricians with good preoperative care and if
possible, during the daytime. Before an operation, each patient and her family should be counseled and
informed regarding the risk for complications included hysterectomy.
Keywords : Cesarean hysterectomy, Placenta previa, Case-control study
