与围产期子宫切除术相关的因素。
Factors associated with peripartum hysterectomy.
作者信息
Bodelon Clara, Bernabe-Ortiz Antonio, Schiff Melissa A, Reed Susan D
机构信息
From the Department of Epidemiology, University of Washington, Seattle, Washington; School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru; Harborview Injury Prevention and Research Center, Seattle, Washington; and Department of Obstetrics and Gynecology, Division of Public Health Sciences, University of Washington, Seattle, Washington.
出版信息
Obstet Gynecol. 2009 Jul;114(1):115-123. doi: 10.1097/AOG.0b013e3181a81cdd.
OBJECTIVE
To identify factors associated with peripartum hysterectomy performed within 30 days postpartum.
METHODS
This was a population-based case-control study using Washington State birth certificate registry (1987-2006) linked to the Comprehensive Hospital Abstract Reporting System. Cases underwent hysterectomy within 30 days postpartum. Controls were frequency matched 4:1. Exposures included factors related to hemorrhage, delivery method, multiple gestations, and infection. Incidence rates of peripartum hysterectomy and maternal and neonatal morbidity and mortality were assessed. Adjusted odds ratios (aORs) by maternal age, parity, gestational age, year of birth, and mode of delivery and 95% confidence intervals (CIs) were computed.
RESULTS
There were 896 hysterectomies. Incidence rates ranged from 0.25 in 1987 to 0.82 per 1,000 deliveries in 2006 (chi for trend, P<.001). Factors related to hemorrhage were strongly related to peripartum hysterectomy. Placenta previa (192 cases compared with 23 controls; aOR 7.9, 95% CI 4.1-15.0), abruptio placenta (71 compared with 55; aOR 3.2, 95% CI 1.8-5.8), and retained placenta (214 compared with 28; aOR 43.0, 95% CI 19.0-97.7) increased the risk of hysterectomy, as did uterine atony, uterine rupture, and thrombocytopenia. Having multiple gestations did not. As compared with vaginal delivery, vaginal delivery after cesarean (27 cases compared with 105 controls; aOR 1.9, 95% CI 1.2-3.0), primary cesarean (270 compared with 504; aOR 4.6, 95% CI 3.5-6.0), and repeat cesarean (296 compared with 231; aOR 7.9, 95% CI 5.8-10.7) increased the risk of peripartum hysterectomy. Among the 111 women who had hysterectomy on readmission (12.8% of cases), hemorrhage- and infection-related factors were still strongly associated with peripartum hysterectomy.
CONCLUSION
Incidence rates of peripartum hysterectomy are increasing over time. The most important risk factor for peripartum hysterectomy is hemorrhage, most notably caused by uterine rupture, retained placenta, and atony of uterus.
LEVEL OF EVIDENCE
II.
目的
确定与产后30天内行围产期子宫切除术相关的因素。
方法
这是一项基于人群的病例对照研究，使用了华盛顿州出生证明登记系统（1987 - 2006年）并与综合医院摘要报告系统相链接。病例为产后30天内行子宫切除术的患者。对照组按4:1进行频率匹配。暴露因素包括与出血、分娩方式、多胎妊娠和感染相关的因素。评估围产期子宫切除术的发病率以及孕产妇和新生儿的发病率和死亡率。计算了按产妇年龄、产次、孕周、出生年份、分娩方式调整后的比值比（aOR）及95%置信区间（CI）。
结果
共进行了896例子宫切除术。发病率从1987年的0.25/1000例到2006年的0.82/1000例（趋势检验χ值，P <.001）。与出血相关的因素与围产期子宫切除术密切相关。前置胎盘（192例与23例对照；aOR 7.9，95% CI 4.1 - 15.0）、胎盘早剥（71例与55例对照；aOR 3.2，95% CI 1.8 - 5.8）和胎盘残留（214例与28例对照；aOR 43.0，95% CI 19.0 - 97.7）增加了子宫切除的风险，子宫收缩乏力、子宫破裂和血小板减少也增加了风险。多胎妊娠则未增加风险。与阴道分娩相比，剖宫产术后阴道分娩（27例与105例对照；aOR 1.9，95% CI 1.2 - 3.0）、初次剖宫产（270例与504例对照；aOR 4.6，95% CI 3.5 - 6.0）和再次剖宫产（296例与231例对照；aOR 7.9，95% CI 5.8 - 10.7）增加了围产期子宫切除术的风险。在111例再次入院时行子宫切除术的女性中（占病例的12.8%），与出血和感染相关的因素仍与围产期子宫切除术密切相关。
结论
围产期子宫切除术的发病率随时间增加。围产期子宫切除术最重要的危险因素是出血，最常见的原因是子宫破裂、胎盘残留和子宫收缩乏力。
证据级别
II级
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