伦敦一家三级医院的紧急围产期子宫切除术

Emergency peripartum hysterectomy in a tertiary London hospital.

作者信息

Selo-Ojeme Dan O, Bhattacharjee Parijat, Izuwa-Njoku Ngozi F, Kadir Rezan A

机构信息

Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, London, UK.

出版信息

Arch Gynecol Obstet. 2005 Feb;271(2):154-9. doi: 10.1007/s00404-004-0715-x. Epub 2005 Feb 3.

DOI:10.1007/s00404-004-0715-x

PMID:15690169

Abstract

OBJECTIVE

The objective was to review all emergency peripartum hysterectomies performed at a tertiary hospital in London, UK, and to identify the risk factors for emergency peripartum hysterectomy.

METHOD

A retrospective case control study. The cases consisted of all women who had emergency peripartum hysterectomy between 1 January 1993 and 31 December 2003. Controls were women who delivered immediately before and after the indexed case. Demographic data, medical and surgical histories, pregnancy, intrapartum and postpartum data were collected. Differences between cases and controls were compared with chi2, Fisher exact and Student t tests. Multiple logistic regression analysis was performed to identify independent risk factors for emergency peripartum hysterectomy.

RESULTS

There were 15 cases of emergency peripartum hysterectomy in 31,079 deliveries, giving a rate of 0.48 per 1,000. Women who had emergency peripartum hysterectomy were significantly older (mean age 37 years vs. 29 years, P<0.001) and multiparous (P=0.02). More of the cases had a history of uterine surgery (67 vs. 30%, P=0.01), placenta praevia (60 vs. 3%, P<0.0001) and were delivered by caesarean section (86.7 vs. 30%, P=0.003). Eighty percent of the hysterectomies were performed in the daytime and all were done by consultants. Haemorrhage due to placenta praevia was the main indication for emergency peripartum hysterectomy (47%). Independent risk factors for emergency peripartum hysterectomy were older age (odds ratios [OR] 1.2, 95% confidence interval [95% CI] 1.2-1.6), multiparity (OR 2.6, 95% CI 1.3-10.2), history of previous caesarean section (OR 13.5, 95% CI 2.7-65.4), caesarean delivery in index pregnancy (OR 11.6, 95% CI 2.1-68.6) and caesarean delivery in index pregnancy for placenta praevia (OR 18, 95% CI 3.6-69).

CONCLUSION

Caesarean deliveries, especially repeat caesareans in women with placenta praevia, significantly increase the risk of emergency peripartum hysterectomy.

摘要

目的

回顾在英国伦敦一家三级医院进行的所有急诊围产期子宫切除术，并确定急诊围产期子宫切除术的风险因素。

方法

一项回顾性病例对照研究。病例包括1993年1月1日至2003年12月31日期间所有接受急诊围产期子宫切除术的女性。对照为在索引病例之前和之后立即分娩的女性。收集人口统计学数据、医疗和手术史、妊娠、产时和产后数据。病例组和对照组之间的差异采用卡方检验、Fisher精确检验和Student t检验进行比较。进行多因素逻辑回归分析以确定急诊围产期子宫切除术的独立风险因素。

结果

在31079例分娩中有15例急诊围产期子宫切除术，发生率为每1000例0.48例。接受急诊围产期子宫切除术的女性年龄显著更大（平均年龄37岁对29岁，P<0.001）且多产（P=0.02）。更多病例有子宫手术史（67%对30%，P=0.01）、前置胎盘（60%对3%，P<0.0001）且通过剖宫产分娩（86.7%对30%，P=0.003）。80%的子宫切除术在白天进行，且均由顾问医生完成。前置胎盘出血是急诊围产期子宫切除术的主要指征（47%）。急诊围产期子宫切除术的独立风险因素为年龄较大（比值比[OR]1.2，95%置信区间[95%CI]1.2 - 1.6）、多产（OR 2.6，95%CI 1.3 - 10.2）、既往剖宫产史（OR 13.5，95%CI 2.7 - 65.4）、索引妊娠剖宫产（OR 11.6，95%CI 2.1 - 68.6）以及索引妊娠因前置胎盘行剖宫产（OR 18，95%CI 3.6 - 69）。