Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands.

Abstract

The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage. This was a 2-year prospective nationwide population-based cohort study. All pregnant women in the Netherlands during the same period acted as reference cohort (n = 371,021). We included 205 women; the overall incidence was 5.7 per 10,000 deliveries. Arterial embolization was performed in 114 women (incidence, 3.2 per 10,000; case fatality rate, 2.0%). Peripartum hysterectomy was performed in 108 women (incidence, 3.0 per 10,000; case fatality rate, 1.9%). Seventeen women underwent hysterectomy after failure of embolization. Cesarean delivery (relative risk, 6.6; 95% confidence interval, 5.0-8.7) and multiple pregnancy (relative risk, 6.6; 95% confidence interval, 4.2-10.4) were the most important risk factors in univariable analysis. The rate of obstetric hemorrhage that necessitates hysterectomy or arterial embolization in the Netherlands is 5.7 per 10,000 deliveries; fertility is preserved in 46% of women by successful arterial embolization.