Emergency postpartum hysterectomy in obstetric practice.

Objectives: To review cases of emergency postpartum hysterectomies performed in the setting of life-threatening hemorrhaging. Methods: A retrospective study of 17 patients who underwent postpartum hysterectomies during January 1, 1985-December 31, 1998 was undertaken. Maternal characteristics, method of delivery, antenatal complications for hysterectomy, obstetric history, placental location, blood loss before hysterectomy and during operation, intraoperative and postoperative complications, and operative procedures were investigated, as was whether prostaglandin F2α and/or oxytocin were administrated during labor. The operative procedures also were examined. Results: The incidence was 1 in 6,978 deliveries (0.014%). All patients were transported from affiliated clinics. The leading cause for a hysterectomy was uterine rupture (35.3%), followed by disseminated intravascular coagulation (DIC) due to placental abruption (29.4%), and uterine atony (23.5%). Failure of internal iliac-artery ligation occurred in 7 patients. Conclusions: Internal iliac-artery ligation is not effective for patients with massive blood loss. In such cases, it is desirable for the private physician to make an early decision for maternal transport.