Demirci Oya, Tuğrul Ahmet S, Yilmaz Ertuğrul, Tosun Özgür, Demirci Elif, Eren Yadigar S
Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey.
J Obstet Gynaecol Res. 2011 Aug;37(8):1054-60. doi: 10.1111/j.1447-0756.2010.01484.x. Epub 2011 Apr 12.
The aim of this study was to estimate the incidence, indications, risk factors, complications, and maternal morbidity and mortality associated with obstetric hysterectomy performed at the Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital between January 2000 and January 2008.
MATERIAL & METHODS: A retrospective study of patients requiring an emergency peripartum hysterectomy (EPH) over a 9-year period was conducted. Emergent peripartum hysterectomy was defined as an operation performed in cases whose bleeding was not prevented by other approaches for 24 h after delivery. Thirty-nine cases of emergency peripartum hysterectomy were performed.
The incidence of emergency peripartum hysterectomy was 0.37 per 1000 deliveries. Thirty-four cases of hysterectomy were performed after cesarean section (CS). The main indication for EPH was placenta accreta (53.8%), followed by uterine atony (25.6%). There were six maternal deaths (15.4%). Severe maternal morbidity included: bladder injury (15.4%), relaparotomy (35.4%), and transfusion >10 unit's red blood cells (15.6%). Both previous CS and CS in the index pregnancy were associated with a significant increased risk of EPH. The number of previous CS was related to an increased risk of placenta accreta; the relative ratio increased from 3.6 for one previous CS to 37 for three or more previous CS.
Emergency peripartum hysterectomy is significantly related to CS in index or previous pregnancy. Placenta accreta is the most common indication to perform peripartum hysterectomy. EPH is associated with a high incidence of maternal morbidity and mortality.
本研究旨在评估2000年1月至2008年1月期间在泽伊内普·卡米尔妇科与儿科培训及研究医院进行的产科子宫切除术的发生率、适应证、危险因素、并发症以及孕产妇发病率和死亡率。
对9年间需要进行急诊围产期子宫切除术（EPH）的患者进行回顾性研究。急诊围产期子宫切除术定义为在分娩后24小时内其他方法无法止血的情况下进行的手术。共进行了39例急诊围产期子宫切除术。
急诊围产期子宫切除术的发生率为每1000例分娩0.37例。34例子宫切除术在剖宫产（CS）后进行。EPH的主要适应证是胎盘植入（53.8%），其次是子宫收缩乏力（25.6%）。有6例孕产妇死亡（15.4%）。严重的孕产妇并发症包括：膀胱损伤（15.4%）、再次剖腹手术（35.4%）以及输注超过10单位红细胞（15.6%）。既往剖宫产史和本次妊娠剖宫产均与EPH风险显著增加相关。既往剖宫产次数与胎盘植入风险增加有关；相对比例从既往1次剖宫产的3.6增加到3次或更多次剖宫产的37。
急诊围产期子宫切除术与本次或既往妊娠的剖宫产显著相关。胎盘植入是进行围产期子宫切除术最常见的适应证。EPH与孕产妇高发病率和死亡率相关。
