Department of Obstetrics and Gynecology, Gaziosmanpasa University, Tokat, Turkey.
Niger J Clin Pract. 2022 Apr;25(4):483-489. doi: 10.4103/njcp.njcp_1722_21.
Peripartum hysterectomy (PPH), which means surgical removal of the uterus during pregnancy or postpartum period, is a life-saving procedure performed as a last resort to stop obstetric serious bleeding.
Evaluation of the prevalence, risk factors, indications, associated complications, and neonatal outcomes of PPH performed in our clinic.
A total of 35 patients who underwent PPH in our clinic between 2013 and 2020 were analyzed retrospectively. Clinical and demographic characteristics of patients, age, gestational week, delivery type, type of hysterectomy performed, length of hospital stay, PPH indications, additional procedures and complications during PPH, maternal and fetal mortality, neonatal characteristics, intensive care unit (ICU) need after PPH, and blood transfusion amount and time were recorded. Patients with PPH were subdivided and studied in subgroups: Emergency - elective surgery, total - subtotal hysterectomy.
PPH was performed in 35 (3.2/1000) patients who gave birth during the study period. The most common indication for hysterectomy was placental invasion anomaly (57.1%, n = 20), and the most performed operation was total hysterectomy (68.6%, n = 24). Bilateral hypogastric artery ligation (14.3%, n = 5) was the most common alternative procedure performed before hysterectomy, and the most common complication was bladder injury (22.9%, n = 8). Blood transfusion was performed in 94.3% (n = 33) of the patients due to acute blood loss. The mean newborn weight was 2788.79 ± 913.37 g, and the 1 and 5-minute APGAR scores were 6.71 ± 2.25 and 7.56 ± 2.35, respectively.
Before PPH, uterine integrity should be preserved using medical and surgical methods, but if success is not achieved, hysterectomy is the last life-saving step. It should be kept in mind that in patients with anemia and increased gravidity, the risk of bleeding may be high in the first 24 h after birth and therefore PPH may be required. It would be more appropriate for patients with placentation anomalies to be operated in experienced centers due to possible complications, increased blood transfusion, and intensive care requirement.
围产期子宫切除术（PPH）是指在妊娠或产后期间进行的子宫切除术，是一种挽救生命的手术，用于阻止产科严重出血。
评估我院行 PPH 的发病率、危险因素、适应证、相关并发症和新生儿结局。
回顾性分析 2013 年至 2020 年我院行 PPH 的 35 例患者。记录患者的临床和人口统计学特征、年龄、孕周、分娩类型、行子宫切除术的类型、住院时间、PPH 适应证、PPH 期间的附加手术和并发症、产妇和胎儿死亡率、新生儿特征、PPH 后需要入住重症监护病房（ICU）、输血量和时间。将行 PPH 的患者分为急诊-择期手术、全子宫切除术-次全子宫切除术亚组进行研究。
在研究期间分娩的 35 例（3.2/1000）患者中进行了 PPH。行子宫切除术的最常见适应证为胎盘植入异常（57.1%，n=20），最常进行的手术为全子宫切除术（68.6%，n=24）。双侧子宫动脉结扎术（14.3%，n=5）是子宫切除术前最常进行的替代手术，最常见的并发症为膀胱损伤（22.9%，n=8）。由于急性失血，94.3%（n=33）的患者进行了输血。新生儿平均体重为 2788.79±913.37g，1 分钟和 5 分钟时的 APGAR 评分为 6.71±2.25 和 7.56±2.35。
在进行 PPH 之前，应使用医疗和手术方法保留子宫的完整性，但如果不成功，子宫切除术是挽救生命的最后一步。应牢记，在贫血和多胎妊娠的患者中，分娩后 24 小时内出血的风险可能较高，因此可能需要进行 PPH。对于胎盘异常的患者，由于可能发生并发症、增加输血和需要重症监护，在有经验的中心进行手术更为合适。
