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Shellhaas, Cynthia S.; Gilbert, Sharon A.; Landon, Mark B.; Varner, Michael W.; Leveno, Kenneth J.; Hauth, John C.; Spong, Catherine Y.; Caritis, Steve N.; Wapner, Ronald J.; & Sorokin, Yoram, et al. (2009). The Frequency and Complication Rates of Hysterectomy Accompanying Cesarean Delivery. Obstetrics & Gynecology, 114(2, Part 1), 224-229. PMCID: PMC2771379


OBJECTIVE: To estimate the frequency, indications, and complications of cesarean hysterectomy.
METHODS: This was a prospective, 2-year observational study at 13 academic medical centers conducted between January 1, 1999, and December 31, 2000, on all women who underwent a hysterectomy at the time of cesarean delivery. Data were abstracted from the medical record by study nurses. The outcomes included procedure frequency, indications, and complications.
RESULTS: A total of 186 cesarean hysterectomies (0.5%) were performed from a cohort of 39,244 women who underwent cesarean delivery. The leading indications for hysterectomy were placenta accreta (38%) and uterine atony (34%). Of the hysterectomy cases with a diagnosis recorded as accreta, 18% accompanied a primary cesarean delivery, and 82% had a prior procedure (P<.001). Of the hysterectomy cases with atony recorded as a diagnosis, 59% complicated primary cesarean delivery, whereas 41% had a prior cesarean (P<.001). Major maternal complications of cesarean hysterectomy included transfusion of red blood cells (84%) and other blood products (34%), fever (11%), subsequent laparotomy (4%), ureteral injury (3%), and death (1.6%). Accreta hysterectomy cases were more likely than atony hysterectomy cases to require ureteral stents (14% compared with 3%, P=.03) and to instill sterile milk into the bladder (23% compared with 8%, P=.02).
CONCLUSION: The rate of cesarean hysterectomy has declined modestly in the past decade. Despite the use of effective therapies and procedures to control hemorrhage at cesarean delivery, a small proportion of women continue to require hysterectomy to control hemorrhage from both uterine atony and placenta accreta.


Reference Type

Journal Article

Year Published


Journal Title

Obstetrics & Gynecology


Shellhaas, Cynthia S.
Gilbert, Sharon A.
Landon, Mark B.
Varner, Michael W.
Leveno, Kenneth J.
Hauth, John C.
Spong, Catherine Y.
Caritis, Steve N.
Wapner, Ronald J.
Sorokin, Yoram
Miodovnik, Menachem
O'Sullivan, Mary Jo
Sibai, Baha M.
Langer, Oded
Gabbe, Steven G., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network [
John M. Thorp, Jr., Member