Yamani Zamzami Tarik Y
Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, PO Box 80215, 21589 Jeddah, Saudi Arabia.
Arch Gynecol Obstet. 2003 Aug;268(3):131-5. doi: 10.1007/s00404-003-0494-9. Epub 2003 May 20.
The objectives were to determine the incidence, indications, associated risk factors and complications with emergency peripartum hysterectomy at King Abdulaziz University Hospital, Saudi Arabia.
This is a retrospective analysis of 17 cases of emergency peripartum hysterectomy done from January 1, 1991 to December 31, 2002.
Seventeen patients of emergency peripartum hysterectomy were identified among 34,379 deliveries and the incidence rate was 0.5 per 1,000. Uterine atony 11 (64.7%, 9 without previa and 2 with previa) and followed by morbid adherent placenta with previa 6 (35.3%, 1 complete placenta accreta and 5 partial adherent placenta) was the most common indication of hysterectomy. Of the atonic group, 3 were primigravidae, 2 of 3 induced and 1 placenta previa. In morbid adherent placenta group the gravidity, previous abortions and prior cesarean deliveries were higher compared to the atonic group and were statistically significant. Conservative surgery performed in 6 (35.3%) patients before proceeding to hysterectomies, 3 (17.7%) patients had uterine artery ligation and 3 (17.7%) internal iliac ligation. Eight (47.1%) hysterectomies were subtotal. Nine (53%) patients developed disseminated intravascular coagulopathy (DIC) and one case (6%) had bilateral ureteric ligation and bladder injury. No maternal deaths occurred.
Uterine atony still is the leading cause of primary postpartum hemorrhage and the main indications of emergency peripartum hysterectomy. The combination of high parity, cesarean section, prior cesarean delivery and current placenta previa were identified as risk factors, and should alert the obstetrician that an emergency peripartum hysterectomy may needed. Although no maternal mortality occurred morbidity remained high.
本研究旨在确定沙特阿拉伯阿卜杜勒阿齐兹国王大学医院急诊剖宫产子宫切除术的发生率、适应证、相关危险因素及并发症。
对1991年1月1日至2002年12月31日期间实施的17例急诊剖宫产子宫切除术进行回顾性分析。
在34379例分娩中，共确定17例急诊剖宫产子宫切除术患者，发病率为每1000例中有0.5例。子宫收缩乏力11例（64.7%，9例无前置胎盘，2例有前置胎盘），其次是前置胎盘合并胎盘植入6例（35.3%，1例完全性胎盘植入，5例部分性胎盘粘连），是子宫切除术最常见的适应证。在子宫收缩乏力组中，3例为初产妇，3例中有2例引产，1例有前置胎盘。与子宫收缩乏力组相比，胎盘植入组的妊娠次数、既往流产史和既往剖宫产史更高，且具有统计学意义。6例（35.3%）患者在进行子宫切除术之前接受了保守手术，3例（17.7%）患者进行了子宫动脉结扎，3例（17.7%）患者进行了髂内动脉结扎。8例（47.1%）子宫切除术为次全子宫切除术。9例（53%）患者发生弥散性血管内凝血（DIC），1例（6%）患者双侧输尿管结扎并伴有膀胱损伤。无孕产妇死亡。
子宫收缩乏力仍是原发性产后出血的主要原因及急诊剖宫产子宫切除术的主要适应证。高孕次、剖宫产、既往剖宫产史及当前前置胎盘的组合被确定为危险因素，应提醒产科医生可能需要进行急诊剖宫产子宫切除术。尽管未发生孕产妇死亡，但发病率仍然很高。
