From the IV Clinic of Obstetrics and Gynecology, University of Bari, and the Clinic of Obstetrics and Gynecology, "San Paolo" Hospital, Bari, Italy; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, California.
Obstet Gynecol. 2010 Mar;115(3):637-644. doi: 10.1097/AOG.0b013e3181cfc007.
To describe factors leading to and outcomes after emergency postpartum hysterectomy for uncontrolled postpartum hemorrhage.
Searches were conducted up to August 2009 using the PubMed, MEDLINE, EMBASE, and Cochrane Library databases, using the following medical subject heading and text words: "postpartum bleeding," "postpartum hysterectomy," "uterine atony," "cesarean hysterectomy," "placenta accreta," "increta," "percreta," and "placenta previa."
Studies were reviewed if they included cases of emergency postpartum hysterectomy performed at the time or within 48 hours of delivery, described factors leading to uncontrolled postpartum hemorrhage, enrolled women who delivered after 24 weeks of gestation, and reported data as proportional rates in tables or text. Studies were excluded if they analyzed hysterectomy performed after 48 hours of delivery or electively for an associated gynecologic condition, enrolled a small sample size (fewer than 10 patients), were conducted in underdeveloped countries, reported data in graphs or percentages, or did not include the actual numbers of patients.
TABULATION, INTEGRATION, AND RESULTS: Twenty-four articles that included 981 cases of emergency postpartum hysterectomy were retrieved. Study characteristics and quality were recorded for each study. Demographic maternal characteristics, previous uterine surgery, conservative procedures to prevent emergency postpartum hysterectomy, type of hysterectomy (total or subtotal), factors leading to emergency postpartum hysterectomy, and maternal morbidity and mortality related to emergency postpartum hysterectomy were abstracted, presented as proportional rates (percentage), and integrated with meta-analysis techniques. The maternal morbidity rate was 549 (56.0%) of 981, and 428 (44.0%) of 981 women required blood transfusion. The maternal mortality rate was 26 (2.6%) of 981 cases. The type of hysterectomy was specified in 601 (61.2%) of 981 cases of emergency postpartum hysterectomy (total hysterectomies, 314 of 601 [52.2%]; subtotal hysterectomies, 287 of 601 [47.8%]). Additional surgery was required in 103 (10.5%) of 981 of cases.
Women at highest risk of emergency hysterectomy are those who are multiparous, had a cesarean delivery in either a previous or the present pregnancy, or had abnormal placentation.
描述导致产后出血失控并进行急诊子宫切除术的相关因素和结局。
截至 2009 年 8 月，使用 PubMed、MEDLINE、EMBASE 和 Cochrane Library 数据库进行了检索，使用了以下医学主题词和文本词：“产后出血”、“产后子宫切除术”、“子宫收缩乏力”、“剖宫产子宫切除术”、“胎盘植入”、“胎盘粘连”、“胎盘穿透”和“前置胎盘”。
如果研究包括在分娩时或分娩后 48 小时内进行的紧急产后子宫切除术的病例，描述导致产后出血失控的相关因素，纳入分娩后 24 周以上的孕妇，并以表格或文本中的比例率报告数据，则纳入研究。如果研究分析的是分娩后 48 小时或因妇科相关疾病而选择性进行的子宫切除术，纳入的样本量较小（少于 10 例），在欠发达国家进行，以图表或百分比形式报告数据，或未报告实际患者数量，则排除研究。
列表、整合和结果：共检索到 24 篇文章，其中包括 981 例紧急产后子宫切除术的病例。对每项研究的研究特征和质量进行了记录。提取了产妇人口统计学特征、既往子宫手术、预防紧急产后子宫切除术的保守措施、子宫切除术类型（全子宫切除术或次全子宫切除术）、导致紧急产后子宫切除术的相关因素，以及与紧急产后子宫切除术相关的产妇发病率和死亡率，并以比例率（百分比）表示，并结合荟萃分析技术进行整合。981 例患者中，产妇发病率为 549 例（56.0%），428 例（44.0%）患者需要输血。981 例病例中，产妇死亡率为 26 例（2.6%）。在 981 例紧急产后子宫切除术病例中，601 例（61.2%）明确了子宫切除术类型（全子宫切除术 314 例[52.2%]；次全子宫切除术 287 例[47.8%]）。981 例中，有 103 例（10.5%）需要进一步手术。
最有可能需要紧急子宫切除术的妇女是多产妇，在前次或本次妊娠中进行过剖宫产，或存在异常胎盘。
Zotero 插件