Senturk Mehmet B, Cakmak Yusuf, Guraslan Hakan, Dogan Keziban
Departments of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey.
Arch Gynecol Obstet. 2015 Nov;292(5):1019-25. doi: 10.1007/s00404-015-3740-z. Epub 2015 May 1.
The aim of this study was to evaluate risk factors, indications and materno-fetal outcomes for emergency peripartum hysterectomy.
Retrospective evaluation was made of 23 cases. Maternal and neonatal outcomes, need for referral to the tertiary center and related complications were compared to those at the initial diagnosis for surgery, location of delivery, type of surgery and the admission diagnosis. The risk factors associated with emergency peripartum hysterectomy were also investigated. Significance was evaluated at p values of <0.01 and <0.05.
There was a correlation between peripartum hysterectomy and uterine atony or uterine rupture (p < 0.01). The referral rates of patients with home delivery were significantly higher than those of patients who delivered in hospital (p = 0.02) but no significant difference was observed in the neonatal outcomes (p = 0.38). There was no significant difference in the rates of maternal complications between home and hospital delivery (p = 0.068). According to the indication for surgery, no significant difference was observed between the rates of referral to the tertiary center, maternal outcomes, complications, or need for maternal intensive care (p > 0.05). However, a highly significant difference was observed between the neonatal outcomes (p = 0.001).
The results of this study showed the most important risk factors associated with peripartum hysterectomy to be uterine atony, grand multiparity, and uterine rupture. Maternal intensive care, maternal death, neonatal death, or neonatal intensive care were associated with home delivery or delayed presentation at hospital.
本研究旨在评估紧急围产期子宫切除术的危险因素、适应症及母婴结局。
对23例病例进行回顾性评估。将母婴结局、转诊至三级中心的需求及相关并发症与手术初始诊断时的情况、分娩地点、手术类型及入院诊断进行比较。还对与紧急围产期子宫切除术相关的危险因素进行了调查。以p值<0.01和<0.05评估显著性。
围产期子宫切除术与子宫收缩乏力或子宫破裂之间存在相关性（p<0.01）。在家分娩患者的转诊率显著高于在医院分娩的患者（p=0.02），但新生儿结局无显著差异（p=0.38）。在家分娩和医院分娩的产妇并发症发生率无显著差异（p=0.068）。根据手术适应症，转诊至三级中心的比率、产妇结局、并发症或产妇重症监护需求之间无显著差异（p>0.05）。然而，新生儿结局之间存在高度显著差异（p=0.001）。
本研究结果表明，与围产期子宫切除术相关的最重要危险因素是子宫收缩乏力、多产和子宫破裂。产妇重症监护、产妇死亡、新生儿死亡或新生儿重症监护与在家分娩或延迟入院有关。
