Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
Acta Obstet Gynecol Scand. 2021 Jul;100(7):1345-1354. doi: 10.1111/aogs.14113. Epub 2021 Mar 14.
Peripartum hysterectomy is applied as a surgical intervention of last resort for major obstetric hemorrhage. It is performed in an emergency setting except for women with a strong suspicion of placenta accreta spectrum (PAS), where it may be anticipated before cesarean section. The aim of this study was to compare management strategies in the case of obstetric hemorrhage leading to hysterectomy, between nine European countries participating in the International Network of Obstetric Survey Systems (INOSS), and to describe pooled maternal and neonatal outcomes following peripartum hysterectomy.
We merged data from nine nationwide or multi-regional obstetric surveillance studies performed in Belgium, Denmark, Finland, France, Italy, the Netherlands, Slovakia, Sweden and the UK collected between 2004 and 2016. Hysterectomies performed from 22 gestational weeks up to 48 h postpartum due to obstetric hemorrhage were included. Stratifying women with and without PAS, procedures performed in the management of obstetric hemorrhage prior to hysterectomy between countries were counted and compared. Prevalence of maternal mortality, complications after hysterectomy and neonatal adverse events (stillbirth or neonatal mortality) were calculated.
A total of 1302 women with peripartum hysterectomy were included. In women without PAS who had major obstetric hemorrhage leading to hysterectomy, uterotonics administration was lowest in Slovakia (48/73, 66%) and highest in Denmark (25/27, 93%), intrauterine balloon use was lowest in Slovakia (1/72, 1%) and highest in Denmark (11/27, 41%), and interventional radiology varied between 0/27 in Denmark and Slovakia to 11/59 (79%) in Belgium. In women with PAS, uterotonics administration was lowest in Finland (5/16, 31%) and highest in the UK (84/103, 82%), intrauterine balloon use varied between 0/14 in Belgium and Slovakia to 29/103 (28%) in the UK. Interventional radiology was lowest in Denmark (0/16) and highest in Finland (9/15, 60%). Maternal mortality occurred in 14/1226 (1%), the most common complications were hematologic (95/1202, 8%) and respiratory (81/1101, 7%). Adverse neonatal events were observed in 79/1259 (6%) births.
Management of obstetric hemorrhage in women who eventually underwent peripartum hysterectomy varied greatly between these nine European countries. This potentially life-saving procedure is associated with substantial adverse maternal and neonatal outcome.
围产期子宫切除术是用于治疗严重产科出血的最后手段的手术干预措施。除了强烈怀疑胎盘植入谱（PAS）的妇女外，它通常在剖宫产前进行，否则它将在紧急情况下进行。本研究的目的是比较在导致子宫切除术的产科出血的情况下，九个参与国际产科调查系统网络（INOSS）的欧洲国家的管理策略，并描述围产期子宫切除术后的母婴合并症。
我们合并了 2004 年至 2016 年间在比利时、丹麦、芬兰、法国、意大利、荷兰、斯洛伐克、瑞典和英国进行的九项全国性或多区域产科监测研究的数据。纳入了因产科出血而在 22 孕周至产后 48 小时内进行的子宫切除术。对伴有和不伴有 PAS 的妇女进行分层，对各国在子宫切除术前治疗产科出血时的手术进行计数和比较。计算了产妇死亡率、子宫切除术后并发症和新生儿不良事件（死产或新生儿死亡）的发生率。
共纳入 1302 例围产期子宫切除术患者。在因产科大出血导致子宫切除术的无 PAS 妇女中，斯洛伐克使用宫缩剂的比例最低（48/73，66%），丹麦最高（25/27，93%），斯洛伐克使用宫内球囊的比例最低（1/72，1%），丹麦最高（11/27，41%），介入放射学在丹麦和斯洛伐克为 0/27，在比利时为 11/59（79%）。在 PAS 妇女中，宫缩剂使用率最低的是芬兰（5/16，31%），最高的是英国（84/103，82%），宫内球囊使用率在比利时和斯洛伐克为 0/14，在英国为 29/103（28%）。介入放射学在丹麦最低（0/16），在芬兰最高（9/15，60%）。产妇死亡率为 14/1226（1%），最常见的并发症是血液学（95/1202，8%）和呼吸系统（81/1101，7%）。在 79/1259（6%）例新生儿中观察到不良事件。
这九个欧洲国家在最终接受围产期子宫切除术的妇女中，产科出血的管理差异很大。这种潜在的救命手术与严重的母婴不良结局相关。
