Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands

Author(s):
Zwart, J.J.; Dijk, P.D.; Roosmalen, J. van
Published
2010
Publication type
Article / Letter to editor

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.

arterial embolization incidence major obstetric hemorrhage peripartum hysterectomy severe maternal morbidity severe maternal morbidity management pregnancy canada
Date issued
2010-02-28
Language
English
Is part of
American Journal of Obstetrics and Gynecology (2010), No. 2
hdl
1887/108767