Department of Obstetrics and Gynecology, Dicle University, Diyarbakir, Turkey.
J Chin Med Assoc. 2010 Jul;73(7):360-3. doi: 10.1016/S1726-4901(10)70078-2.
We conducted this retrospective study to evaluate the outcomes and indications of emergency peripartum hysterectomy (EPH) as a life-saving procedure.
We analyzed a series of 140 cases of EPH, between January 1993 and December 2008 in our clinic, retrospectively. The data were collected from the patients' files. The incidence, demographic characteristics, risk factors, indications and outcomes of hysterectomy, peripartum complications, the operation types, maternal morbidity and mortality and fetal mortality were evaluated.
A total of 26,015 of women were delivered. The incidence of EPH was 5.38 per 1,000 deliveries. The mean age was 34.19 +/- 6.04 years (range, 21-49 years), gravidity was 6.84 +/- 3.38 (1-17) and parity was 5.58 +/- 3.04 (0-15). Of the 140 cases, 90 were delivered by cesarean section [29 (20.71%) of these had had a previous cesarean section] and 50 were vaginally delivered. One hundred and five cases had subtotal hysterectomy and 35 had total abdominal hysterectomy. The most common indications for EPH were uterine atony followed by uterine rupture and abnormal placentation. Mean operation time was 142.23 +/- 43.70 minutes. The average blood transfusion was 4.79 +/- 3.36 (1-14) units. Relaparotomy was performed in 23 cases. Maternal mortality was seen in 13 cases. Seventy-nine of the cases delivered at an outside center and were referred to our clinic for the intensive care unit. Sixty-one of the cases delivered at our clinic and 31 had stillbirths.
This study suggests that the most common indications for EPH are uterine atony, uterine rupture and abnormal placentation. This is probably due to the advanced age of pregnancies and multiparity in our region. Therefore, we believe that the risk of EPH may be decreased with appropriate and closer prenatal care as well as education of the pregnant women.
本研究旨在评价紧急剖宫产子宫切除术（EPH）作为一种救命手术的结局和适应证。
我们回顾性分析了 1993 年 1 月至 2008 年 12 月期间在我院接受 EPH 的 140 例病例。数据从患者病历中采集。评估了子宫切除术的发生率、人口统计学特征、危险因素、适应证和结局、围产期并发症、手术类型、产妇发病率和死亡率以及胎儿死亡率。
共有 26015 名妇女分娩。EPH 的发生率为 5.38/1000 例。平均年龄为 34.19 ± 6.04 岁（范围 21-49 岁），孕次为 6.84 ± 3.38（1-17）次，产次为 5.58 ± 3.04（0-15）次。在 140 例病例中，90 例为剖宫产分娩（其中 29 例（20.71%）有剖宫产史），50 例为阴道分娩。105 例行次全子宫切除术，35 例行全子宫切除术。EPH 的最常见适应证为宫缩乏力，其次为子宫破裂和异常胎盘。平均手术时间为 142.23 ± 43.70 分钟。平均输血 4.79 ± 3.36 单位（1-14 单位）。23 例患者行再次剖腹探查术。产妇死亡 13 例。79 例在院外分娩并转至我院重症监护病房。61 例在我院分娩，31 例死胎。
本研究表明，EPH 的最常见适应证为宫缩乏力、子宫破裂和异常胎盘。这可能是由于本地区妊娠年龄较大和多产所致。因此，我们认为，通过适当和更密切的产前保健以及对孕妇进行教育，可能会降低 EPH 的风险。
