Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial
Abstract Background Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. Methods We use...
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doaj-aae119d608f54a7886d74e3428a7a3312020-11-24T21:34:07ZengBMCBMC Pregnancy and Childbirth1471-23932018-05-011811810.1186/s12884-018-1829-7Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trialSumaya Huque0Ian Roberts1Bukola Fawole2Rizwana Chaudhri3Sabaratnam Arulkumaran4Haleema Shakur-Still5Clinical Trials Unit, London School of Hygiene and Tropical MedicineClinical Trials Unit, London School of Hygiene and Tropical MedicineDepartment of Obstetrics and Gynaecology, National Institute of Maternal and Child Health, College of Medicine, University of IbadanDepartment of Obstetrics and Gynaecology, Rawalpindi Medical UniversitySt George’s UniversityClinical Trials Unit, London School of Hygiene and Tropical MedicineAbstract Background Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. Methods We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. Results Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7–3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6–5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9–1.7). Conclusions Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia.http://link.springer.com/article/10.1186/s12884-018-1829-7Peripartum hysterectomyPostpartum haemorrhagePlacenta accretaCaesarean sectionAsiaAfrica |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sumaya Huque Ian Roberts Bukola Fawole Rizwana Chaudhri Sabaratnam Arulkumaran Haleema Shakur-Still |
spellingShingle |
Sumaya Huque Ian Roberts Bukola Fawole Rizwana Chaudhri Sabaratnam Arulkumaran Haleema Shakur-Still Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial BMC Pregnancy and Childbirth Peripartum hysterectomy Postpartum haemorrhage Placenta accreta Caesarean section Asia Africa |
author_facet |
Sumaya Huque Ian Roberts Bukola Fawole Rizwana Chaudhri Sabaratnam Arulkumaran Haleema Shakur-Still |
author_sort |
Sumaya Huque |
title |
Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial |
title_short |
Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial |
title_full |
Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial |
title_fullStr |
Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial |
title_full_unstemmed |
Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial |
title_sort |
risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the woman trial |
publisher |
BMC |
series |
BMC Pregnancy and Childbirth |
issn |
1471-2393 |
publishDate |
2018-05-01 |
description |
Abstract Background Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. Methods We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. Results Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7–3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6–5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9–1.7). Conclusions Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia. |
topic |
Peripartum hysterectomy Postpartum haemorrhage Placenta accreta Caesarean section Asia Africa |
url |
http://link.springer.com/article/10.1186/s12884-018-1829-7 |
work_keys_str_mv |
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