Glaze Sarah, Ekwalanga Pauline, Roberts Gregory, Lange Ian, Birch Colin, Rosengarten Albert, Jarrell John, Ross Sue
Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada.
Obstet Gynecol. 2008 Mar;111(3):732-8. doi: 10.1097/AOG.0b013e31816569f2.
To estimate the rate of peripartum hysterectomy over the last 8 years in Calgary, the primary indication for peripartum hysterectomy (defined as any hysterectomy performed within 24 hours of a delivery), and whether there was an increase in the rate of peripartum hysterectomy during that time.
Detailed chart review of all cases of peripartum hysterectomy, 1999-2006, including previous obstetric history, details of the index pregnancy, indications for peripartum hysterectomy, outcome of the hysterectomy, and infant morbidity.
The overall rate of peripartum hysterectomy was 87 of 108,154 or 0.8 per 1,000 deliveries. The primary indications for hysterectomy were uterine atony (32 of 87, 37%) and suspected placenta accreta (29 of 87, 33%). After hysterectomy, 46 (53%) women were admitted to the intensive care unit. Women were discharged home after a mean 6-day length of stay. The rate of peripartum hysterectomy did not appear to increase over time.
Our population-based study found that abnormal placentation is the main indication for peripartum hysterectomy. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk, although even perfect management of hemorrhage cannot always prevent surgery.
评估卡尔加里过去8年中围产期子宫切除术的发生率、围产期子宫切除术（定义为在分娩后24小时内进行的任何子宫切除术）的主要指征，以及在此期间围产期子宫切除术的发生率是否有所增加。
对1999年至2006年期间所有围产期子宫切除术病例进行详细的病历审查，包括既往产科病史、本次妊娠详情、围产期子宫切除术的指征、子宫切除术后的结果以及婴儿发病率。
围产期子宫切除术的总体发生率为108154例中有87例，即每1000例分娩中有0.8例。子宫切除术的主要指征是宫缩乏力（87例中的32例，37%）和疑似胎盘植入（87例中的29例，33%）。子宫切除术后，46名（53%）妇女被收入重症监护病房。妇女平均住院6天后出院。围产期子宫切除术的发生率似乎没有随时间增加。
我们基于人群的研究发现，胎盘异常是围产期子宫切除术的主要指征。预防严重产后出血的最重要步骤是识别和评估妇女的风险，尽管即使对出血进行完美管理也不能总是避免手术。
