Chen Lichun, Wu Baohua, Han Qing, Yan Jianying
Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China.
J Int Med Res. 2020 Feb;48(2):300060519879294. doi: 10.1177/0300060519879294. Epub 2019 Oct 29.
This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.
This retrospective study was performed from January 2004 to December 2017. Patients with intractable postpartum hemorrhage were grouped according to the initial pathogenesis as determined by exploratory laparotomy: uterine atony, placental factors, coagulation dysfunction, or uterine rupture.
This study involved 72 patients who underwent emergency exploratory laparotomy, accounting for 0.04% of total deliveries. Uterine preservation surgery and hysterectomy were performed in 31 and 41 patients, respectively. Abnormal events upon returning to the ward were primarily vaginal hemorrhage and pelvic hematoma. The frequency of uterine artery ligation was lower in the hysterectomy group than uterine preservation group. The prothrombin activity level, fibrinogen level, and platelet count before surgery were lower in the hysterectomy group than uterine preservation group. The international normalized ratio and activated partial thromboplastin time were higher in the hysterectomy group than uterine preservation group. In total, 44 patients developed complications.
Placental implantation is a primary cause of hysterectomy after emergency laparotomy. However, the possibility of postpartum hemorrhage caused by coagulation disorders should not be ignored.
本研究旨在探讨难治性产后出血患者急诊剖腹探查的原因及临床特征。
本回顾性研究于2004年1月至2017年12月进行。将难治性产后出血患者根据剖腹探查确定的初始发病机制进行分组：子宫收缩乏力、胎盘因素、凝血功能障碍或子宫破裂。
本研究纳入72例行急诊剖腹探查的患者，占总分娩数的0.04%。分别有31例和41例患者接受了子宫保留手术和子宫切除术。返回病房后的异常情况主要为阴道出血和盆腔血肿。子宫切除术组子宫动脉结扎的频率低于子宫保留组。子宫切除术组术前的凝血酶原活性水平、纤维蛋白原水平和血小板计数低于子宫保留组。子宫切除术组的国际标准化比值和活化部分凝血活酶时间高于子宫保留组。共有44例患者发生并发症。
胎盘植入是急诊剖腹探查术后子宫切除的主要原因。然而，凝血障碍导致产后出血的可能性也不应被忽视。
