Coad Sarah L, Dahlgren Leanne S, Hutcheon Jennifer A
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Obstet Gynecol. 2017 Sep;217(3):377.e1-377.e6. doi: 10.1016/j.ajog.2017.05.018. Epub 2017 May 15.
Puerperal uterine inversion is a rare, potentially life-threatening obstetrical emergency. The current literature consists of small case series and a single nationwide study from Europe with only 15 cases.
We aimed to define the incidence, temporal trends, and outcomes in women with uterine inversion using a nationally representative US cohort.
We used the Nationwide Inpatient Sample, a 20% sample of US hospital admissions, to identify all deliveries from 2004 through 2013. International Classification of Diseases, Ninth Revision diagnosis codes were used to identify cases of uterine inversion and associated adverse outcomes (maternal death, blood transfusion, maternal shock, need for surgical correction, and length of hospital stay). The incidence of uterine inversion overall and for each year of the study period was calculated with 95% confidence intervals. The case fatality and incidence of other adverse outcomes among women with a uterine inversion were also estimated.
Among 8,294,279 deliveries in 2004 through 2013, there were 2427 cases of puerperal uterine inversion, corresponding to an incidence of 2.9 per 10,000 deliveries (95% confidence interval, 2.8-3.0). There was 1 maternal death in our cohort (4.1 per 10,000 events). No change in the incidence of uterine inversion over the study period was detected. Among women with a uterine inversion, 37.7% (95% confidence interval, 35.8-39.6%) had an associated postpartum hemorrhage, 22.4% (95% confidence interval, 20.7-24.0%) received a blood transfusion, and 6.0% (95% confidence interval, 5.1-7.0%) required surgical management. Only 2.8% (95% confidence interval, 2.1-3.5%) underwent a hysterectomy. The median length of hospital stay was 3 days.
This study provides the largest population-based results on puerperal uterine inversion to date and highlights the high likelihood of adverse maternal outcomes associated with the condition. The results inform the optimization of clinical management, by preparing for possible postpartum hemorrhage, need for blood products, and surgical management in the rare event of uterine inversion.
产后子宫内翻是一种罕见的、可能危及生命的产科急症。目前的文献包括小病例系列研究以及一项来自欧洲的仅有15例病例的全国性研究。
我们旨在利用具有全国代表性的美国队列确定子宫内翻女性的发病率、时间趋势及结局。
我们使用全国住院患者样本（美国医院入院病例的20%样本）来识别2004年至2013年期间的所有分娩病例。使用国际疾病分类第九版诊断编码来识别子宫内翻病例及相关不良结局（孕产妇死亡、输血、产妇休克、手术矫正需求及住院时间）。计算研究期间总体及每年子宫内翻的发病率，并给出95%置信区间。还估计了子宫内翻女性的病死率及其他不良结局的发生率。
在2004年至2013年期间的8294279例分娩中，有2427例产后子宫内翻病例，发病率为每10000例分娩2.9例（95%置信区间为2.8 - 3.0）。我们的队列中有1例孕产妇死亡（每10000例事件4.1例）。研究期间未检测到子宫内翻发病率的变化。子宫内翻女性中，37.7%（95%置信区间为35.8 - 39.6%）伴有产后出血，22.4%（95%置信区间为20.7 - 24.0%）接受了输血，6.0%（95%置信区间为5.1 - 7.0%）需要手术治疗。仅2.8%（95%置信区间为2.1 - 3.5%）接受了子宫切除术。住院时间中位数为3天。
本研究提供了迄今为止基于最大人群的产后子宫内翻结果，并突出了与该病症相关的孕产妇不良结局的高可能性。这些结果有助于优化临床管理，为可能出现的产后出血、血液制品需求以及罕见的子宫内翻事件中的手术管理做好准备。
