来自单一三级中心的产后子宫切除术后的孕产妇及围产期结局

Maternal and perinatal outcomes following peripartum hysterectomy from a single tertiary centre.

作者信息

Jones Bryony, Zhang Eko, Alzouebi Aisha, Robbins Tanya, Paterson-Brown Sara, Prior Tomas, Kumar Sailesh

机构信息

Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK.

出版信息

Aust N Z J Obstet Gynaecol. 2013 Dec;53(6):561-5. doi: 10.1111/ajo.12135. Epub 2013 Oct 19.

DOI:10.1111/ajo.12135

PMID:24138323

Abstract

BACKGROUND

We investigated the indications for and maternal and perinatal outcomes following peripartum hysterectomy in a single large tertiary centre.

MATERIALS AND METHODS

All cases of peripartum hysterectomy between 2000 and 2011 were investigated. Data regarding maternal demographics, previous obstetric and gynaecological history, indications for hysterectomy, and details of haemorrhage, surgical complications and neonatal outcomes were collected.

RESULTS

There were 47 cases of peripartum hysterectomy of 55 262 births giving an incidence of 0.85 per 1000 births. Forty-one cases were total hysterectomies, while six were subtotal procedures. A total of 70.2% of cases were performed because of a morbidly adherent placenta, 27.7% for uterine atony and 2.1% for uterine rupture. The median estimated blood loss was 7290 mL. The overall surgical complication rate was 44.6% with bladder injury (19.1%) and sepsis (12.8%) commonest. Intensive care admission was required in 57.4% of women.

CONCLUSIONS

Peripartum hysterectomy is a major procedure carrying a high morbidity rate. In this series, maternal survival was 100%.

摘要

背景

我们在一家大型三级医疗中心调查了围产期子宫切除的指征以及孕产妇和围产儿结局。

材料与方法

对2000年至2011年间所有围产期子宫切除病例进行调查。收集有关孕产妇人口统计学、既往产科和妇科病史、子宫切除指征以及出血细节、手术并发症和新生儿结局的数据。

结果

在55262例分娩中有47例围产期子宫切除，发生率为每1000例分娩0.85例。41例为全子宫切除，6例为次全子宫切除。70.2%的病例因胎盘植入而行手术，27.7%因宫缩乏力，2.1%因子宫破裂。估计中位失血量为7290毫升。总体手术并发症发生率为44.6%，最常见的是膀胱损伤（19.1%）和败血症（12.8%）。57.4%的女性需要入住重症监护病房。