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Incidence and Determinants of Peripartum Hysterectomy

From the ¹Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; ²Comforce Technical Services Inc., Los Angeles, California; and ³Agency for Healthcare Research and Quality, Rockville, Maryland.

OBJECTIVE: Most studies of peripartum hysterectomy are conducted in single institutions, limiting the ability to provide national incidence estimates and examine risk factors. The objective of this study was to provide a national estimate of the incidence of peripartum hysterectomy and to examine factors associated with the procedure.

METHODS: We used data for 1998–2003 from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationally representative survey of inpatient hospitalizations. Peripartum hysterectomy was defined as a hysterectomy and delivery occurring during the same hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for maternal and hospital characteristics using logistic regression.

RESULTS: During 1998–2003, an estimated 18,339 peripartum hysterectomies occurred in the United States (0.77 per 1,000 deliveries). Compared with vaginal delivery without a previous cesarean delivery, the ORs of peripartum hysterectomy for other delivery types were as follows: repeat cesarean, 8.90 (95% CI 8.09–9.79); primary cesarean, 6.54 (95% CI 5.95–7.18); and vaginal birth after cesarean, 2.70 (95% CI 2.23–3.26). Multiple births were associated with an increased risk compared with singleton births (OR 1.41, 95% CI 1.16–1.71).

CONCLUSION: Our results suggest that vaginal birth after cesarean, primary and repeat cesarean deliveries, and multiple births are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern, given the increasing rate of both cesarean deliveries and multiple births in the United States.

LEVEL OF EVIDENCE: III

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