Enes Serhat COŞKUN, Havva Betül BACAK
Cam and Sakura Medical Journal - 2026;6(1):24-32
Objective: Peripartum/postpartum hysterectomy is a rare but life-saving intervention for uncontrolled obstetric hemorrhage. Placenta accreta spectrum (PAS) and uterine atony are the most common indications; yet their clinical context and operative pathways may differ, particularly in centers where PAS is managed under urgent or emergent conditions. We evaluated indications, surgical management, and outcomes over a 10-year period and explored differences between uterine atony-related and PAS-related cases. Material and Methods: This retrospective, single-center study included women who underwent peripartum or postpartum hysterectomy for uncontrolled obstetric hemorrhage between January 2015 and June 2025. Cases were classified as uterine atony or PAS/placenta previa-related hemorrhage based on operative findings, clinical course, and pathology. Continuous variables were summarized as median [interquartile range (IQR)] and compared using the Mann-Whitney U test; categorical variables were compared using Fisher's exact test. Effect estimates with 95% confidence intervals (bootstrap for continuous variables) are provided in the tables; comparisons were exploratory. Results: Among 31,571 deliveries, 34 hemorrhage-related peripartum/postpartum hysterectomies were identified (incidence: 1.1 per 1,000 deliveries): 18 for uterine atony (52.9%) and 16 for PAS-related hemorrhage (47.1%). All PAS cases met an a priori definition of urgent or emergent. Transfusion requirements were higher in the uterine atony group than in the PAS group, with median packed red blood cells (PRBCs) of 4 (3-6) vs. 2 (0.8-3.2) units (p=0.003), and median fresh frozen plasma of 2 (2-4) vs. 1 (0-2.2) units (p=0.020). Intensive care unit (ICU) admission occurred in 66.7% of uterine atony cases and in 43.8% of PAS cases (p=0.300). Overall ICU length of stay (including 0.0 days for non-admitted patients) was 1.0 (0.0-2.0) days vs. 0.0 (0.0-1.0) days (p=0.048). Median hospital stay was 6.5 (5.0-11.0) vs. 5.5 (4.0-7.0) days (p=0.265). One maternal death occurred in the uterine atony group; none occurred in the PAS group. Conclusion: Hemorrhage-related peripartum/postpartum hysterectomy was rare but associated with substantial maternal morbidity. PAS cases were managed predominantly in urgent or emergent conditions. Exploratory comparisons suggested a greater transfusion burden and longer ICU stays among uterine atony cases, underscoring institutional preparedness, timely escalation, and multidisciplinary hemorrhage management.
