Ministry of Health, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
Arch Gynecol Obstet. 2012 Nov;286(5):1131-4. doi: 10.1007/s00404-012-2434-z. Epub 2012 Jun 29.
To determine the incidence, indications and the risk factors of emergency peripartum hysterectomy (EPH).
We analyzed retrospectively 30 cases of emergency peripartum hysterectomy performed at the Obstetrics Department of a tertiary, research and education hospital between the years of 2006 and 2010. Demographic, medical and clinical data of the patients were recorded. Data stored were expressed as mean ± standard deviation.
There were 30 cases of EPH among 82,363 deliveries. The overall incidence of EPH was 0.364 per 1,000 deliveries from 2006 to 2010. Nine hysterectomies were performed after vaginal delivery (0.16/1,000 vaginal deliveries) and the remaining 21 hysterectomies were performed after cesarean section (0.78/1,000 cesarean sections). Two cases (6.7 %) were performed as subtotal and remaining 28 cases (93.3 %) were performed as total hysterectomy. Indications of EPH were uterine atony (43.3 %, 13/30), placenta accreta (40.0 %, 12/30) and uterine rupture (16.7 %, 5/30). All patients [7/7 (100 %)] with placenta previa and 11 of 12 patients (91.7 %) with placenta accreta had previously cesarean sections. There were two maternal deaths due to coagulopathy and pulmonary embolism. Two stillbirths (6.6 %) and 2 early neonatal deaths (6.6 %) were recorded.
It should be kept in mind that cases of placenta previa and/or placenta accreta with previous cesarean sections have a very high probability of EPH. The delivery should be performed in suitable clinical settings with experienced surgeons when the risk factors like placenta previa and/or placenta accreta are determined so as to achieve optimal outcome.
确定紧急围产期子宫切除术（EPH）的发生率、适应证和危险因素。
我们回顾性分析了 2006 年至 2010 年在一家三级研究和教学医院妇产科进行的 30 例紧急围产期子宫切除术。记录患者的人口统计学、医疗和临床数据。存储的数据表示为平均值±标准差。
在 82363 例分娩中，有 30 例发生 EPH。2006 年至 2010 年 EPH 的总发生率为每 1000 例分娩 0.364 例。9 例子宫切除术是在阴道分娩后进行的（每 1000 例阴道分娩 0.16 例），其余 21 例是在剖宫产术后进行的（每 1000 例剖宫产 0.78 例）。2 例（6.7%）行次全子宫切除术，28 例（93.3%）行全子宫切除术。EPH 的适应证为子宫收缩乏力（43.3%，13/30）、胎盘植入（40.0%，12/30）和子宫破裂（16.7%，5/30）。所有（7/7，100%）前置胎盘患者和 12 例胎盘植入患者中的 11 例（91.7%）均有剖宫产史。有 2 例产妇因凝血功能障碍和肺栓塞死亡。记录到 2 例死胎（6.6%）和 2 例新生儿早期死亡（6.6%）。
应记住，前置胎盘和/或有剖宫产史的胎盘植入患者发生 EPH 的可能性非常高。当确定前置胎盘和/或胎盘植入等危险因素时，应在有经验的外科医生在合适的临床环境下进行分娩，以获得最佳结果。
