Korejo Razia, Nasir Ayesha, Yasmin Haleema, Bhutta Shereen
Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
J Pak Med Assoc. 2012 Dec;62(12):1322-5.
To assess the frequency of obstetric hysterectomy, its indications and associated maternal and perinatal morbidity and mortality.
The retrospective observational analytical study was conducted at the Department of Obstetrics and Gynaecology, Unit-I, Jinnah Postgraduate Medical Centre, Karachi from January 2003 to December 2009. Records of all patients who had underone hysterectomy at the study centre during the study period were explored for age, parity, booking status indication and the type of operation performed. Maternal and foetal morbidity and mortality were also recorded. SPSS 13.0 was used for statistical analysis.
Against the total 44,612 deliveries during the period, 121 hysterectomies were performed for obstetric indications. The frequency of the procedure, as such, was 1 in 368 (0.27%) deliveries. The major indications were ruptured uterus in 57 (47.1%), and severe postpartum haemorrhage due to atony of uterus in 35 (28.9%). Other indications included severe haemorrhage due to placental abnormalities in 14 (11.6%); placenta previa in 3 (2.5%); abruptio placenta in 4 (3.3%); and severe infection following vaginal delivery in 3 (2.5%). Infection was the commonest complication seen in 14 (11.6%) patients. There were 11 (9.0%) maternal deaths and 65 (53.7%) perinatal deaths.
Emergency obstetric hysterectomy remains a necessary tool for consultant obstetricians. Acting at the optimal time with clear judgment, and professional surgical technique can reduce morbidity and mortality in such cases.
评估产科子宫切除术的发生率、其指征以及相关的孕产妇和围产期发病率及死亡率。
2003年1月至2009年12月在卡拉奇真纳研究生医学中心第一单元妇产科进行了回顾性观察分析研究。对研究期间在研究中心接受子宫切除术的所有患者的记录进行了年龄、产次、登记状态指征及所施行手术类型的探究。还记录了孕产妇和胎儿的发病率及死亡率。使用SPSS 13.0进行统计分析。
在此期间的44612例分娩中，因产科指征进行了121例子宫切除术。该手术的发生率为每368例分娩中有1例（0.27%）。主要指征为子宫破裂57例（47.1%），子宫收缩乏力导致的严重产后出血35例（28.9%）。其他指征包括胎盘异常导致的严重出血14例（11.6%）；前置胎盘3例（2.5%）；胎盘早剥4例（3.3%）；以及阴道分娩后严重感染3例（2.5%）。感染是14例（11.6%）患者中最常见的并发症。有11例（9.0%）孕产妇死亡和65例（53.7%）围产期死亡。
急诊产科子宫切除术仍然是产科顾问医生的必要手段。在最佳时机做出清晰判断并运用专业手术技术可降低此类病例的发病率和死亡率。
