Emergency Peripartum Hysterectomy due to Placenta Previa/Accreta: 10 Years' Experience

Objective: To identify risk factors for and sonographic findings, complications and outcomes of emergency peripartum hysterectomy due to placenta previa/accreta. Materials and Methods: This was a retrospective review and descriptive study of women who underwent emergency peripartum hysterectomy due to placenta previa/accreta at Chang Gung Memorial Hospital between 1992 and 2001. All emergency peripartum hysterectomies were considered by the responsible physician to be a lifesaving procedure. Each chart was reviewed with emphasis on risk factors, sonographic findings, complications and outcomes. Results: There were 16 cases of emergency peripartum hysterectomy due to placenta previa/accreta (0.6/1,000 births). The mean hospitalization time was 8 days (range, 5-24 days) and the mean operation time was about 150 minutes (range, 85-335 mins). The estimated mean blood loss was 3,800 mL (range, 2,700-12,000 mL) and the mean amount of whole blood transfused was 15 units (range, 10-38 units). Two cases of bladder injury occurred when dissecting the bladder from the lower uterine segment and cervix. Conclusion: The association of placenta previa and prior cesarean delivery with placenta accreta and emergency peripartum hysterectomy is well documented. Emergency peripartum hysterectomy remains a potentially lifesaving procedure with which every practitioner of obstetrics must be familiar. In facilities that have interventional radiological services and well-trained angiographers available on a 24-hour basis, prophylactic placement of catheters for possible selective embolization may be considered in patients with placenta previa and a prior cesarean section and sonographic findings of placenta accreta. There should be a clear, tried and tested protocol for dealing with massive obstetric hemorrhage to decrease maternal morbidity and mortality.