Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.
Acta Obstet Gynecol Scand. 2020 Oct;99(10):1364-1373. doi: 10.1111/aogs.13892. Epub 2020 May 21.
Peripartum hysterectomy is a surgical procedure performed for severe obstetric complications such as major obstetric hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. Hence, international comparisons and studying indications and associations with mode of birth rely on the use of national obstetric survey data. Objectives were to calculate the prevalence and indications of peripartum hysterectomy and its association with national cesarean section rates and mode of birth in nine European countries.
We performed a descriptive, multinational, population-based study among women who underwent peripartum hysterectomy. Data were collected from national or multiregional databases from nine countries participating in the International Network of Obstetric Survey Systems. We included hysterectomies performed from 22 gestational weeks up to 48 hours postpartum for obstetric hemorrhage, as this was the most restrictive, overlapping case definition between all countries. Main outcomes were prevalence and indications of peripartum hysterectomy. Additionally, we compared prevalence of peripartum hysterectomy between women giving birth vaginally and by cesarean section, and between women giving birth with and without previous cesarean section. Finally, we calculated correlation between prevalence of peripartum hysterectomy and national cesarean section rates, as well as national rates of women giving birth after a previous cesarean section.
A total of 1302 peripartum hysterectomies were performed in 2 498 013 births, leading to a prevalence of 5.2 per 10 000 births ranging from 2.6 in Denmark to 10.7 in Italy. Main indications were uterine atony (35.3%) and abnormally invasive placenta (34.8%). Relative risk of hysterectomy after cesarean section compared with vaginal birth was 9.1 (95% CI 8.0-10.4). Relative risk for hysterectomy for birth after previous cesarean section compared with birth without previous cesarean section was 10.6 (95% CI 9.4-12.1). A strong correlation was observed between national cesarean section rate and prevalence of peripartum hysterectomy (ρ = 0.67, P < .05).
Prevalence of peripartum hysterectomy may vary considerably between high-income countries. Uterine atony and abnormally invasive placenta are the commonest indications for hysterectomy. Birth by cesarean section and birth after previous cesarean section are associated with nine-fold increased risk of peripartum hysterectomy.
围产期子宫切除术是一种用于治疗严重产科并发症的手术，如大出血。在资源丰富的环境中，围产期子宫切除术的发生率相对较低。因此，国际比较以及研究与分娩方式相关的指征和关联依赖于使用国家产科调查数据。目的是计算九个欧洲国家围产期子宫切除术的发生率和指征及其与全国剖宫产率和分娩方式的关系。
我们对在围产期接受子宫切除术的妇女进行了一项描述性、多国、基于人群的研究。数据来自参与国际产科调查系统网络的九个国家的国家或多区域数据库。我们纳入了从 22 孕周至产后 48 小时因产科出血而行的子宫切除术，因为这是所有国家之间最具限制性和重叠的病例定义。主要结局是围产期子宫切除术的发生率和指征。此外，我们比较了阴道分娩和剖宫产分娩妇女之间、有和无既往剖宫产妇女之间围产期子宫切除术的发生率。最后，我们计算了围产期子宫切除术发生率与全国剖宫产率以及全国有既往剖宫产史妇女分娩率之间的相关性。
在 2498013 例分娩中，共有 1302 例围产期子宫切除术，发生率为每 10000 例分娩 5.2 例，范围为丹麦的 2.6 例至意大利的 10.7 例。主要指征为子宫收缩乏力（35.3%）和异常侵袭性胎盘（34.8%）。与阴道分娩相比，剖宫产术后子宫切除术的相对风险为 9.1（95%CI 8.0-10.4）。与无既往剖宫产史分娩相比，有既往剖宫产史分娩的子宫切除术相对风险为 10.6（95%CI 9.4-12.1）。全国剖宫产率与围产期子宫切除术发生率之间存在很强的相关性（ρ=0.67，P<0.05）。
围产期子宫切除术的发生率在高收入国家之间可能有很大差异。子宫收缩乏力和异常侵袭性胎盘是子宫切除术最常见的指征。剖宫产分娩和有既往剖宫产史分娩与围产期子宫切除术的风险增加 9 倍相关。
