Peripartum Hysterectomy Strongly Linked to Earlier Cesarean

A new study has found that past cesarean (c-section) delivery markedly increases the risk of peripartum hysterectomy, an operation typically performed for life-threatening obstetric hemorrhage.

Researchers from the University of Oxford (UK) conducted a population-based, case-control comparison of data involving 318 women who had a hysterectomy following childbirth and 614 matched women who did not. The results of the study showed that the incidence of hysterectomy following childbirth was 4.1 cases per 10,000 births. Overall, prior c-section increased the odds of peripartum hysterectomy 3.52-fold. However, this risk changed depending on the number of prior c-sections. The study showed that a c-section in the current pregnancy raised the risk 7.13-fold. Women who had two or more previous deliveries had more than 18 times the risk. Other risk factors for peripartum hysterectomy included maternal age over 35 years, parity of three or greater, previous manual placental removal, twin pregnancy, and, the strongest of all, previous myomectomy, which increased the risk 14-fold. The researchers believe that a prior c-section may increase the risk of peripartum hysterectomy by causing the placenta to grow either too low or through the wall of the womb. The study was published in the January 2008 issue of Obstetrics and Gynecology.

"It is important that women who have had a previous cesarean delivery are assessed in the last third of pregnancy to determine whether the placenta has grown in an abnormal site,” said lead author Marian Knight, M.D. "This way, we can help to identify women who are at risk of severe bleeding so that measures can be taken to try to prevent it.”


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