Saeed Ferha, Khalid Roha, Khan Abdullah, Masheer Shazia, Rizvi Javed H
Department of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan.
Trop Doct. 2010 Jan;40(1):18-21. doi: 10.1258/td.2009.080245. Epub 2009 Dec 11.
Acute bleeding after delivery can be a life-threatening complication. Emergency hysterectomy is usually undertaken as a last resort. This study was conducted in order to estimate the incidence, indications, risk factors and complications associated with peripartum hysterectomy performed at a tertiary care hospital. We retrospectively analysed 39 of 45 cases of emergency peripartum hysterectomy performed at the Aga Khan University Hospital from 1997-2006. Peripartum hysterectomy was defined as one performed for a haemorrhage after delivery which is unresponsive to other treatments. The most frequent indications for peripartum hysterectomy were morbidly adherent placenta (46%) and uterine atony (23%). The duration of surgery was shorter (P = 0.045) but the complications were higher (P = 0.029) in total compared with subtotal hysterectomies. Our results suggest that caesarean deliveries are associated with an increased risk for peripartum hysterectomy, which is of concern given the increasing rate of caesarean deliveries. Subtotal hysterectomy is a reasonable alternative in emergency obstetric hysterectomy.
产后急性出血可能是一种危及生命的并发症。紧急子宫切除术通常是在万不得已的情况下进行。本研究旨在估计在一家三级护理医院进行的围产期子宫切除术的发生率、适应症、危险因素及并发症。我们回顾性分析了1997年至2006年在阿迦汗大学医院进行的45例紧急围产期子宫切除术中的39例。围产期子宫切除术定义为因产后出血且对其他治疗无反应而进行的手术。围产期子宫切除术最常见的适应症是胎盘植入（46%）和子宫收缩乏力（23%）。与次全子宫切除术相比，手术时间较短（P = 0.045），但总的并发症发生率较高（P = 0.029）。我们的结果表明，剖宫产与围产期子宫切除术风险增加有关，鉴于剖宫产率不断上升，这令人担忧。次全子宫切除术是紧急产科子宫切除术中一种合理的替代方法。
