Obstetric Hysterectomy at a Greek Tertiary Referral Center: Differences in Maternal and Neonatal Outcomes Between Elective and Urgent Procedures.

Background

Obstetric hysterectomy remains a life-saving intervention for placenta accreta spectrum and uncontrolled obstetric hemorrhage. Evidence regarding the outcomes of planned versus urgent obstetric hysterectomy in contemporary tertiary practice in Greece remains limited. We compared maternal and neonatal outcomes between elective and urgent procedures at a tertiary referral center in Thessaloniki.

Methods

We retrospectively reviewed 30 women who underwent obstetric hysterectomy between January 2020 and June 2025. The elective group included women with prenatal PAS diagnosis and planned delivery at ≥34 weeks (n = 17), whereas the urgent group included women requiring unplanned delivery for hemorrhage or active labor without prior surgical preparation (n = 13). Maternal characteristics, intraoperative findings, transfusion requirements, complications, hospital stay, and neonatal outcomes were compared using bivariate statistical tests.

Results

Maternal age was similar between groups (36.1 ± 6.1 vs. 37.9 ± 6.8 years; p = 0.44). Elective cases had higher parity (median 3 vs. 1; p = 0.002), had more previous cesarean deliveries (median 2 vs. 0; p = 0.002), and were more frequently diagnosed with placenta previa (p = 0.027). Uterine atony occurred more often in urgent cases (p < 0.001). Bakri balloon tamponade was used only in urgent cases and failed to control hemorrhage (p < 0.001). Operative time, transfusion requirement, hospital stay, and urinary tract injury rates were comparable. No maternal deaths occurred. Birth weight, Apgar scores, and NICU admission rates were also similar.

Conclusions

Planned obstetric hysterectomy within a multidisciplinary setting was associated with fewer emergency hemorrhage-control interventions, while major perioperative and neonatal outcomes were comparable between groups.