Losing your uterus
Rare, and almost always because of bleeding or a placenta problem.
In a prospective study of 39,244 cesareans, hysterectomy was performed in 186 women, or 0.5%. The leading reasons were placenta accreta (38%) and a uterus that would not contract (34%). Among those women, 84% received red cell transfusions, 3% had a ureter injury, 4% needed another operation, and 1.6% died.
In a national sample restricted to low and moderate risk deliveries, excluding known accreta and previa with prior cesarean, hysterectomy occurred in about 1 in 1,913 deliveries.
The risk rises steeply with the number of prior cesareans: 0.65% at the first, 2.41% at the fourth, and 8.99% at the sixth or more.
Where this comes from:
268. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-1232.
308. Shellhaas CS, Gilbert S, Landon MB, Varner MW, Leveno KJ, Hauth JC, et al. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol. 2009;114(2 Pt 1):224-229.
349. Friedman AM, Wright JD, Ananth CV, Siddiq Z, D'Alton ME, Bateman BT. Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations. Am J Obstet Gynecol. 2016;215(5):640.e1-640.e8.
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