A Comprehensive Study on Peripartum Hysterectomy in Tehran, Iran: Causes and Clinical Outcomes

Abstract

Background: Peripartum hysterectomy (PH) poses a notable public health challenge due to its correlation with severe maternal morbidity and mortality. Identifying the causes and risk factors associated with PH is crucial for enhancing preventive strategies and maternal health outcomes. This study investigates the indications, and outcomes of PH across healthcare settings.

Methods: This is a retrospective analysis of all PH cases between March 2021 and March 2022 in Tehran, Iran. The study included cases where gestational age was greater than 24 weeks, with PH performed during delivery or within the first 24 hours postpartum. Data, including demographic and clinical variables, were collected from the Iranian Maternal and Neonatal Network (IMaN) system.

Results: In total, 136 PH cases were identified. The average age of the women was 35.1 (±5.2) years. Cesarean section (C/S) was the predominant delivery method, comprising 93.4% of cases, with 44.9% having a medical indication, 7.4% without indications, and 41.2% performed as emergency C/S. Notably, a previous C/S was reported in 65.4% of cases. The main indications for PH were placenta abnormalities (75.6%), uterine atony (20.7%), uterine rupture (3%), and ovarian mass (0.7%). Placenta previa (42.6%) and placenta accreta (32.4%) were the most frequent placental abnormalities.

Conclusion: The findings highlight key factors influencing PH that may inform health policies to mitigate risks. A national study could offer a comprehensive view, accounting for regional, socioeconomic, and cultural differences, emergency healthcare access, and resource availability, guiding targeted public health interventions.

Keywords: Peripartum hysterectomy; Placenta accreta spectrum; Public health; Uterine atony.