Association of obstetrical Hysterectomy with rising rates of cesarean section among women with Placenta Previa

OBJECTIVE: To analyze the impact of previous cesarean section on rates of obstetrical hysterectomy among women with placenta previa. METHODS: A retrospective cohort study done at the Department of Obstetrics & Gynecology, Nishtar University Hospital, Multan from January 2017 to December 2021. A total of 374 women aged between 20 to 50 years with diagnosis of placenta previa who underwent cesarean delivery were included. Age, BMI, area of residence, gestational age, gravidity status and past history of cesarean section were noted from medical records of all women. Relationship of previous number of cesarean sections and with obstetrical hysterectomy was noted among women with placenta previa. RESULTS: In a total of 374 women, mean age was 33.45±7.3 years. Mean gestational age was 37.4±3 weeks. Obstetrical hysterectomy was done in 110 (29.4%) women. Significant association of gravidity status was noted with hysterectomy as 95 (86.4%) women with hysterectomy had gravidity status ≥3 in comparison to 197 (74.6%) with no hysterectomy (p=0.030). Number of cesarean section was found to have significant association with obstetrical hysterectomy as 55 (50.0%) women with obstetrical hysterectomy reported ≥3 previous cesarean section versus 29 (11.0%) with no obstetrical hysterectomy (p<0.001). CONCLUSION: Strong association of previous number of cesarean section and obstetrical hysterectomy was found with placenta previa. There should be protocols for early identification and prediction of adverse outcomes among women with placenta previa with past history of cesarean section.