Qatawneh Ayman, Fram Kamil M, Thikerallah Fida, Mhidat Nadia, Fram Farah K, Fram Rand K, Darwish Tamara, Abdallat Tala
Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan.
Prz Menopauzalny. 2020 Jul;19(2):66-71. doi: 10.5114/pm.2020.97840. Epub 2020 Jul 13.
Emergency peripartum hysterectomy (EPH) is a foremost operation and is perpetually implemented in the presence of life intimidating hemorrhage during or immediately after abdominal or vaginal deliveries. The aim of this study was to review cases managed at the Department of Gynecology and Obstetrics at Jordan University Hospital (JUH).
All women who underwent EPH due to any cause in the period from January 2010, to December 2017 were included in the study. Data were collected retrospectively using the patients' files namelessly. Main measures: age, gravidity, parity, number of previous cesarean sections, previous uterine surgeries, indication for hysterectomy, complications, antepartum bleeding and the need for blood transfusion.
In total, 74 cases of EPH were managed during the study period. The incidence of EPH ranged from 0.24 to 8.7 per 1000 deliveries. EPH was found to be more common following cesarean sections than vaginal deliveries. The prime indication was abnormal placentation, uterine atony, and uterine rupture. The risk factors included previous cesarean sections, scarred uteruses, multiparity, older age group. Maternal morbidity ranged from 26.5 to 31.5% and mortality from 0 to 12.5% with a mean of 4.8%.
EPH is the most demanding obstetric surgery performed in very tiresome circumstances of life threatening hemorrhage. The indication for EPH in recent years has changed from outdated uterine atony to abnormal placentation. Antenatal eagerness of the risk factors, engrossment of proficient obstetricians at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in tumbling morbidity and mortality.
急诊围产期子宫切除术（EPH）是一项首要手术，在腹部或阴道分娩期间或之后出现危及生命的出血时会一直实施。本研究的目的是回顾约旦大学医院（JUH）妇产科处理的病例。
纳入2010年1月至2017年12月期间因任何原因接受EPH的所有女性。使用患者档案匿名回顾性收集数据。主要测量指标：年龄、孕次、产次、既往剖宫产次数、既往子宫手术史、子宫切除指征、并发症、产前出血及输血需求。
在研究期间共处理了74例EPH病例。EPH的发生率为每1000例分娩0.24至8.7例。发现EPH在剖宫产后比阴道分娩后更常见。主要指征是胎盘异常、子宫收缩乏力和子宫破裂。危险因素包括既往剖宫产史、子宫瘢痕、多产、年龄较大组。孕产妇发病率为26.5%至31.5%，死亡率为0至12.5%，平均为4.8%。
EPH是在危及生命的出血这种非常棘手的情况下进行的最具挑战性的产科手术。近年来EPH的指征已从过时的子宫收缩乏力转变为胎盘异常。产前对危险因素的关注、在管理早期有经验丰富的产科医生参与以及在充分复苏后迅速进行子宫切除术将大大降低发病率和死亡率。
