(745) Peripartum Hysterectomy: evolving trends over 50 years in a single European city

The objective of this study was to determine trends in incidence of, and indications for, peripartum hysterectomy (PH) over 50 years at a single European city.

Study Design:

A retrospective cohort study was performed between 1966 and 2022 of PH cases performed  in the three large tertiary obstetric hospitals of a single European city. After identifying all cases, data were collected from the published clinical reports of all three hospitals.

Results:

During the 56 years, there were 1,332,115 deliveries, with 596 PH performed (0.5/1,000 deliveries). When comparing study periods, PH incidence in the most recent seven year period 2016-2022 ( 0.74/1,000 deliveries) has returned to 1966-1975 levels (0.85/1,000 deliveries) despite transient reduced incidence between 1986-2006 (0.2/1,000 deliveries). The indications for PH have changed significantly over the years. While uterine rupture was the main indication for PH in early years, it is now rare decreasing from 41% to 1% (p< 0.001). Placenta accreta spectrum (PAS) has significantly overtaken other indications for PH from 5% to 32% (p< 0.001). The focus towards antenatal diagnosis of PAS and optimizing surgical management is reflected in our study, with a notable increase in rates of elective PH from 14% to 26% (p< 0.001). A strong correlation was observed between the cesarean delivery rate (6% - 37%) and the prevalence of peripartum hysterectomy in this large obstetric population (p< 0.001).

Conclusion:

The influence of increased cesarean deliveries internationally is reflected in the increasing incidence of PH, largely for PAS cases and the increased role of elective PH. Our data serve to inform how emergency obstetric practice has evolved over five decades and in turn may be helpful in the focus on training required for PH in the future.