Joost J Zwart1, Pieter D Dijk, Jos van Roosmalen. 1. Department of Obstetrics, K6-P-35, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. j.j.zwart@lumc.nl
Abstract
OBJECTIVE: The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage. STUDY DESIGN: This was a 2-year prospective nationwide population-based cohort study. All pregnant women in the Netherlands during the same period acted as reference cohort (n = 371,021). RESULTS: We included 205 women; the overall incidence was 5.7 per 10,000 deliveries. Arterial embolization was performed in 114 women (incidence, 3.2 per 10,000; case fatality rate, 2.0%). Peripartum hysterectomy was performed in 108 women (incidence, 3.0 per 10,000; case fatality rate, 1.9%). Seventeen women underwent hysterectomy after failure of embolization. Cesarean delivery (relative risk, 6.6; 95% confidence interval, 5.0-8.7) and multiple pregnancy (relative risk, 6.6; 95% confidence interval, 4.2-10.4) were the most important risk factors in univariable analysis. CONCLUSION: The rate of obstetric hemorrhage that necessitates hysterectomy or arterial embolization in the Netherlands is 5.7 per 10,000 deliveries; fertility is preserved in 46% of women by successful arterial embolization. Copyright 2010 Mosby, Inc. All rights reserved.
OBJECTIVE: The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage. STUDY DESIGN: This was a 2-year prospective nationwide population-based cohort study. All pregnant women in the Netherlands during the same period acted as reference cohort (n = 371,021). RESULTS: We included 205 women; the overall incidence was 5.7 per 10,000 deliveries. Arterial embolization was performed in 114 women (incidence, 3.2 per 10,000; case fatality rate, 2.0%). Peripartum hysterectomy was performed in 108 women (incidence, 3.0 per 10,000; case fatality rate, 1.9%). Seventeen women underwent hysterectomy after failure of embolization. Cesarean delivery (relative risk, 6.6; 95% confidence interval, 5.0-8.7) and multiple pregnancy (relative risk, 6.6; 95% confidence interval, 4.2-10.4) were the most important risk factors in univariable analysis. CONCLUSION: The rate of obstetric hemorrhage that necessitates hysterectomy or arterial embolization in the Netherlands is 5.7 per 10,000 deliveries; fertility is preserved in 46% of women by successful arterial embolization. Copyright 2010 Mosby, Inc. All rights reserved.
Authors: Babette W Prick; Joost F von Schmidt Auf Altenstadt; Chantal W P M Hukkelhoven; Gouke J Bonsel; Eric A P Steegers; Ben W Mol; Joke M Schutte; Kitty W M Bloemenkamp; Johannes J Duvekot Journal: BMC Pregnancy Childbirth Date: 2015-02-21 Impact factor: 3.007