Yucel Oguz, Ozdemir Ismail, Yucel Nese, Somunkiran Asli
Department of Obstetrics and Gynecology, Duzce School of Medicine, Abant Izzet Baysal University, 81620, Konuralp, Duzce, Turkey.
Arch Gynecol Obstet. 2006 May;274(2):84-7. doi: 10.1007/s00404-006-0124-4. Epub 2006 Feb 7.
To determine the incidence, indications, risk factors, and complications of emergency peripartum hysterectomy.
A retrospective study of the patients requiring an emergency peripartum hysterectomy of a 9-year period was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 h after delivery. Demographic and clinical variables were obtained from the maternal records.
There were 34 emergency peripartum hysterectomies out of 117,095 deliveries for a rate of 0.29 per 1,000. Of the 16 cases that were delivered by cesarean section, seven had a previous cesarean section and 18 cases were delivered vaginally, including two using vacuum extraction. Total hysterectomy was performed in 24 patients, and subtotal hysterectomy in ten patients. The indications for hysterectomy were uterine rupture (n=12), placenta accreta (n=10), uterine atony (n=7), and hemorrhage (n=5). There were two maternal deaths, six stillbirths, and two early neonatal deaths.
This study identified surgical deliveries, uterine rupture, placenta accreta, and uterine atony as risk factors for emergency peripartum hysterectomy. The most common reason for abnormal placental adherence was a previous cesarean section. Multiparity and oxytocin use for uterine stimulation were among the risk factors for uterine atony that necessitated emergency peripartum hysterectomy.
确定紧急剖宫产子宫切除术的发生率、适应证、危险因素及并发症。
对9年间需要进行紧急剖宫产子宫切除术的患者进行回顾性研究。紧急剖宫产子宫切除术定义为在分娩后24小时内因其他治疗无效的出血而进行的手术。人口统计学和临床变量从产妇记录中获取。
117,095例分娩中有34例紧急剖宫产子宫切除术，发生率为每1000例0.29例。16例剖宫产分娩中，7例曾有剖宫产史，18例经阴道分娩，其中2例使用了真空吸引术。24例行全子宫切除术，10例行次全子宫切除术。子宫切除术的适应证为子宫破裂（n = 12）、胎盘植入（n = 10）、子宫收缩乏力（n = 7）和出血（n = 5）。有2例产妇死亡、6例死产和2例早期新生儿死亡。
本研究确定手术分娩、子宫破裂、胎盘植入和子宫收缩乏力是紧急剖宫产子宫切除术的危险因素。胎盘异常附着的最常见原因是既往剖宫产史。多胎妊娠和使用缩宫素刺激子宫是导致子宫收缩乏力而需紧急剖宫产子宫切除术的危险因素。
