Omole-Ohonsi Abiodun, Taiwo Olayinka Hassan
Associate Professor, Department of Obstetrics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria.
Senior Registrar, Department of Obstetrics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria.
J Obstet Gynaecol Can. 2012 Oct;34(10):954-960. doi: 10.1016/S1701-2163(16)35409-3.
Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure that is associated with maternal morbidity and mortality, especially in developing countries. The advent of newer medical and conservative surgical methods of controlling postpartum hemorrhage will influence both the rate and the outcomes of the procedure.
To study the rate of EPH, the influence of sociodemographic characteristics on the rate of the procedure, the modality of treatment used in each of the indications, and maternal-fetal morbidity and mortality.
We conducted a case-control study of 30 patients who underwent EPH between June 1, 2003, and 31 May 31, 2008, at Aminu Kano Teaching Hospital, Kano, Nigeria, a tertiary institution in a developing country.
The rate of EPH in this study was 4.0 per 1000 deliveries. Ruptured uterus (73.3%) was the most common indication. Factors showing a significant association with EPH were being 31 to 40 years old (OR 6.7; 95% CI 3.9 to 15.7), being para ≥ 5 (OR 4.1; 95% CI 1.87 to 9.1), having unbooked status (OR 9.1; 95% CI 3.6 to 24.9), and being in a low social class (OR 7.5; 95% CI 1.7 to 45.3). Ruptured uterus (OR 164.3; 95% CI 67.9 to 410.0) and placenta previa accreta (OR 36.1; 95% CI 10.0 to 117.3) were significantly associated with EPH. The most common morbidity was wound sepsis (60%). The case fatality rate was 13.3%, and perinatal mortality was 73.3%.
The rate of EPH in our institution is high, and maternal-fetal outcome is poor. Antenatal care and hospital delivery should be encouraged.
紧急围产期子宫切除术（EPH）是一种挽救生命的外科手术，与孕产妇的发病率和死亡率相关，尤其是在发展中国家。控制产后出血的更新的医学和保守手术方法的出现将影响该手术的发生率和结果。
研究EPH的发生率、社会人口学特征对该手术发生率的影响、每种适应症所采用的治疗方式以及母婴发病率和死亡率。
我们在尼日利亚卡诺的阿米努·卡诺教学医院（一家发展中国家的三级医疗机构）对2003年6月1日至2008年5月31日期间接受EPH的30例患者进行了病例对照研究。
本研究中EPH的发生率为每1000例分娩4.0例。子宫破裂（73.3%）是最常见的适应症。与EPH有显著关联的因素包括年龄在31至40岁（比值比6.7；95%置信区间3.9至15.7）、经产妇≥5次（比值比4.1；95%置信区间1.87至9.1）、未登记状态（比值比9.1；95%置信区间3.6至24.9）以及社会阶层较低（比值比7.5；95%置信区间1.7至45.3）。子宫破裂（比值比164.3；95%置信区间67.9至410.0）和胎盘植入（比值比36.1；95%置信区间10.0至117.3）与EPH显著相关。最常见的并发症是伤口感染（60%）。病死率为13.3%，围产期死亡率为73.3%。
我们机构的EPH发生率较高，母婴结局较差。应鼓励进行产前护理和住院分娩。
