Maternal characteristics, clinical indications, and neonatal outcomes in cesarean hysterectomy: A cross-sectional study

Abstract

Abstract Background Cesarean hysterectomy (CH) is a life-saving surgical procedure performed in obstetric emergencies, particularly in cases of uncontrollable hemorrhage, placenta previa, and abnormal placental adherence. Objective This study aimed to evaluate the maternal characteristics, associated clinical factors, complications, and neonatal outcomes observed in CH. Materials and Methods In this cross-sectional study, data of 89 women who underwent CH at Sayad Shirazi hospital, Gorgan, Iran, between 2013 and 2022 were extracted from participants' medical records using a structured checklist covering maternal demographics, comorbidities, placental conditions, surgical outcomes, and neonatal results. Results The mean maternal age was 34.65 ± 5.2 yr, body mass index 28.78 ± 3.4 kg/m², and gestational age 34.54 ± 3.2 wk. Placenta previa was present in 88.6% of cases, with placenta increta (46.1%), accreta (29.2%), and percreta (21.3%) being the most common placenta accreta spectrum subtypes. Preoperative and postoperative hemoglobin levels were 11.2 ± 1.8 and 8.15 ± 1.56 g/dL, respectively. Blood transfusion was required in 94.4% of cases. Intensive care unit admission was required in 93.3%, with a mean stay of 2.01 ± 0.11 days. Intraoperative organ injury occurred in 20.2% of cases. Mean neonatal birth weight was 2414.61 ± 682 gr, with 68.1% requiring neonatal intensive care unit admission primarily due to prematurity. No maternal or neonatal deaths occurred. Conclusion Placenta previa and placenta accreta spectrum disorders are the primary risk factors for CH. Adequate preparation, including blood product reserves and intensive care unit/neonatal intensive care unit availability, is essential for managing these high-risk cases. As a descriptive study without a comparison group, these findings reflect observed patterns rather than causal associations.