D'Arpe Stella, Franceschetti Silvia, Corosu Roberto, Palaia Innocenza, Di Donato Violante, Perniola Giorgia, Muzii Ludovico, Benedetti Panici Pierluigi
Department of Gynecology, Obstetrics and Urology, Policlinico Umberto I, University "Sapienza", Viale del Policlinico, 155, 00155, Rome, Italy,
Arch Gynecol Obstet. 2015 Apr;291(4):841-7. doi: 10.1007/s00404-014-3487-y. Epub 2014 Sep 25.
To determine incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a tertiary teaching hospital and to compare the results with literature data.
Retrospective study of 51 patients who underwent EPH at the Department of Gynecology, Obstetrics and Urology of the University of Rome Sapienza, from January 2000 to December 2013. Maternal characteristics of the index pregnancy and delivery, indications for EPH, operative and postoperative complications, maternal and neonatal outcome were acquired by the hospital records. Fisher's and Chi-square tests were performed for statistical analysis.
There were 51 EPH out of 23,384 deliveries, for an incidence of 2.2 per 1,000 deliveries during the study period. Forty-nine EPHs were performed after caesarean delivery (CS) and two after vaginal delivery (p < 0.0001). The most common indications were abnormal placentation (49.0%), followed by uterine atony (41.2%), and uterine rupture (9.8%). Eighty percent of patients who underwent EPH with abnormal placentation had at least one previous CS (p < 0.01). Twenty-three patients (45.1%) underwent total hysterectomy, the most frequent indication being abnormal placentation (76%, p < 0.01). The remaining 28 patients underwent subtotal hysterectomy (54.9%), the most frequent indication being uterine atony (85.7%, p < 0.01). Maternal morbidity was 25.5% and mortality was 5.9%. Perinatal mortality was 3.9%.
Abnormal placentation was the most common indication for EPH, requiring in most of the cases a total hysterectomy. Previous CS was a risk factor for abnormal placentation and in particular for pathological adherence of the placenta. EPH remains associated with a high incidence of morbidity and mortality.
确定在一家三级教学医院进行的急诊围产期子宫切除术（EPH）的发生率、危险因素、适应症、结局及并发症，并将结果与文献数据进行比较。
对2000年1月至2013年12月在罗马第二大学妇产科和泌尿外科接受EPH的51例患者进行回顾性研究。通过医院记录获取本次妊娠和分娩的产妇特征、EPH的适应症、手术及术后并发症、产妇和新生儿结局。采用Fisher检验和卡方检验进行统计分析。
在23384例分娩中有51例EPH，研究期间每1000例分娩的发生率为2.2例。49例EPH在剖宫产（CS）后进行，2例在阴道分娩后进行（p<0.0001）。最常见的适应症是胎盘异常（49.0%），其次是子宫收缩乏力（41.2%）和子宫破裂（9.8%）。因胎盘异常接受EPH的患者中，80%既往至少有一次CS（p<0.01）。23例患者（45.1%）接受了全子宫切除术，最常见的适应症是胎盘异常（76%，p<0.01）。其余28例患者接受了次全子宫切除术（54.9%），最常见的适应症是子宫收缩乏力（85.7%，p<0.01）。产妇发病率为25.5%，死亡率为5.9%。围产期死亡率为3.9%。
胎盘异常是EPH最常见的适应症，在大多数情况下需要进行全子宫切除术。既往CS是胎盘异常尤其是胎盘病理粘连的危险因素。EPH仍然与高发病率和死亡率相关。
