Objective: The aim of this study is to identify the association as well as the incidence of peripartum hysterectomy in high-risk patients.

Methods. This study was conducted at Aziz Bhatti Shaheed Hospital Gujrat, Pakistan from 1 January 2018 to 31 December 2021. Data of 200 cases of peripartum hysterectomy collected that were done at the hospital during the study duration were the part of the study. The participant was randomly selected and their data was stumbled through the medical history of patients obtained by the hospital staff before the treatment and during treatment. Various maternal characteristics as age, education level, number of previous births smoking, and material status were obtained through medical Performa.  Main risk factors included abnormal placentation, uterine rupture, hemorrhagic factors, Delivery methods, and multiple gestations were determined. Adjusted odds ratios OR were measured the association of risk factors with peripartum hysterectomy through the stratified analysis. Confidence intervals for the incidence rates were based on the Poisson distribution for a count of 100 or less.

Results: Vaginal delivery had less risk of peripartum hysterectomy with OR (95% CL) = 3.5 (1.4-3.5) in 20 (10%) patients. Twist risk was found in 40 (20.0%) patients who had Vaginal delivery after cesarean with OR (95% CL) = 6.1 (4.1-5.9). Higher risk was measured in patients with cesarean delivery OR (95% CL) = 6.8 (4.8-10.6) and repeated cesarean OR (95% CL) 33 (17.0-78.0). So, we measured the highest incidence of peripartum hysterectomy in repeated cesarean cases. Patients with placental abnormality were strongly associated with peripartum hysterectomy. 71 (35.5%) patients with adherent placenta, OR (95% CL) = 22 (14.0-57.2) had highest association with peripartum hysterectomy. Its incidence rate is 22 fold greater than placenta previa and placenta abruption. As 48 (24.00%) patients were found with Placenta Previa, OR (95% CL) = 6.3 (3.3-10.4) and 20 (10.0%) patients were found with Placental abruption, OR (95% CL) = 4.1 (1.6-4.5).

Conclusion: eventually, we found placental abnormalities are the most critical situation had a strong association with peripartum hysterectomy especially adherent placenta. This shows the highest value of confidence intervals that indicates its higher incidence rate among the other factors. 

Keywords: peripartum hysterectomy, adherent placenta, placenta previa