台湾地区的产后子宫切除术
Peripartum hysterectomy in Taiwan.
作者信息
Jou Hei-Jen, Hung Hsin-Wen, Ling Pei-Ying, Chen Shih-Ming, Wu Shiao-Chi
机构信息
Department of Obstetrics and Gynecology, Taiwan Adventist Hospital, Taipei, Taiwan.
出版信息
Int J Gynaecol Obstet. 2008 Jun;101(3):269-72. doi: 10.1016/j.ijgo.2007.12.004. Epub 2008 Mar 4.
OBJECTIVE
To investigate the incidence and associated risk factors for peripartum hysterectomy in singleton pregnancies.
METHODS
A retrospective cohort study of all women with singleton pregnancies admitted for delivery in 2002 taken from the National Healthcare Insurance database. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for maternal and hospital characteristics using logistic regression.
RESULTS
There were 287 peripartum hysterectomies in 214 237 singleton pregnancies (0.13%). Cesarean delivery, vaginal birth after cesarean (VBAC), and repeat cesarean delivery had higher hysterectomy rates than vaginal delivery, with adjusted ORs of 12.13 (95% CI 8.30-17.74), 5.12 (95% CI 1.19-21.92), and 3.84 (95% CI 2.52-5.86), respectively. Pregnancies complicated with placenta previa, gestational diabetes mellitus (GDM), and premature labor were associated with significantly increased risks for peripartum hysterectomy (P<0.05).
CONCLUSION
Risk factors for peripartum hysterectomy included cesarean delivery, VBAC, repeat cesarean, placenta previa, GDM, and premature labor. VBAC and repeat cesarean had a similar risk.
目的
探讨单胎妊娠分娩期子宫切除术的发生率及相关危险因素。
方法
对2002年从国家医疗保险数据库中选取的所有单胎妊娠分娩妇女进行回顾性队列研究。采用逻辑回归分析计算孕产妇和医院特征的调整比值比（OR）和95%置信区间（CI）。
结果
214237例单胎妊娠中有287例进行了分娩期子宫切除术（0.13%）。剖宫产、剖宫产术后阴道分娩（VBAC）和再次剖宫产的子宫切除率高于阴道分娩，调整后的OR分别为12.13（95%CI 8.30-17.74）、5.12（95%CI 1.19-21.92）和3.84（95%CI 2.52-5.86）。合并前置胎盘、妊娠期糖尿病（GDM）和早产的妊娠与分娩期子宫切除术风险显著增加相关（P<0.05）。
结论
分娩期子宫切除术的危险因素包括剖宫产、VBAC、再次剖宫产、前置胎盘、GDM和早产。VBAC和再次剖宫产的风险相似。
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