Outcome of supracervical compared to total hysterectomy for emergency peripartum hemorrhage: a systematic review and meta-analysis

Objective: This study aimed to report the outcomes between patients who underwent emergency supracervical abdominal hysterectomy and those who underwent emergency total hysterectomy for postpartum hemorrhage. Data sources: A systematic search was performed on Medline, Embase, and Cochrane Library from January 2000 to December 2024 using Medical Subject Headings terms and key words related to peripartum hysterectomy and maternal outcomes. Study eligibility criteria: This study included observational cohort and case-control studies of patients who underwent supracervical hysterectomy vs total hysterectomy for postpartum hemorrhage within 24 hours of delivery and studies exclusively reporting cases with placenta accreta spectrum, case reports, conference abstracts, and studies with <10 cases per arm. Methods: This study had 2 independent reviewers to screen studies, extract data, and assess the quality of studies using the Newcastle-Ottawa Scale. Head-to-head meta-analyses were performed using random-effects models. Heterogeneity (I2) and publication bias were assessed. Results: A total of 25 studies were included, analyzing 1478 patients (715 patients in the supracervical hysterectomy group and 763 patients in the total hysterectomy group). No significant difference was found in maternal mortality (P=.532), intensive care unit admission (P=.415), reoperation (P=.884), or major complications (P>.05). Supracervical hysterectomy was associated with a lower risk of ureteric injuries (odds ratio, 0.38 [95% confidence interval, 0.18-0.77]; P=.007), reduced estimated blood loss (mean difference, -446.03 mL [95% confidence interval, -747.72 to -144.35]; P=.004), fewer blood transfusions (mean difference, -1.46 units [95% confidence interval, -2.37 to -1.14]; P=.002), and shorter operative time (mean difference, -53.22 minutes [95% confidence interval, -86.48 to -19.95]; P=.002). Conclusion: Supracervical hysterectomy seems to offer advantages over total hysterectomy in postpartum hemorrhage cases, particularly in reducing ureteric injuries, operative time, and blood loss. However, heterogeneity and lack of standardized placenta accreta spectrum diagnostic criteria limit the generalizability of the findings. Future research with standardized protocols is required to refine surgical decision-making.