Kallianidis Athanasios F, Rijntjes Douwe, Brobbel Carolien, Dekkers Olaf M, Bloemenkamp Kitty W M, van den Akker Thomas
Department of Obstetrics and Gynecology and the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Division Woman and Baby, Department of Obstetrics, Birth Center Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, and the Athena Institute, VU, Amsterdam, the Netherlands; and Mbuma Mission Hospital, Mbuma, Zimbabwe.
Obstet Gynecol. 2023 Jan 1;141(1):35-48. doi: 10.1097/AOG.0000000000005022. Epub 2022 Nov 30.
To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings.
PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021.
Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8,775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting.
TABULATION, INTEGRATION, AND RESULTS: The meta-analysis included 154 studies: 14,409 emergency peripartum hysterectomies were performed in 17,127,499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1,000 births (95% CI 1.0-1.3). The highest incidence was observed in lower middle-income settings (3/1,000 births, 95% CI 2.5-3.5), and the lowest incidence was observed in high-income settings (0.7/1,000 births, 95% CI 0.5-0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9-42.4), uterine atony (27.0%, 95% CI 24.6-29.5), and uterine rupture (21.2%, 95% CI 17.8-25.0). In lower middle-income countries, uterine rupture (44.5%, 95% CI 36.6-52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5-53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2,706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3-81.9). The most common complications were febrile (29.7%, 95% CI 25.4-34.3) and hematologic (27.5%, 95% CI 20.4-35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5-4.2) and was higher in lower middle-income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9-14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6-1.6).
Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.
描述全球范围内紧急剖宫产子宫切除术的发生率、适应证、危险因素、结局及管理，并比较不同收入水平地区的结局。
截至2021年12月10日的PubMed、MEDLINE、EMBASE、ClinicalTrials.gov、Cochrane图书馆、科学网和Emcare数据库。
对一项系统评价和荟萃分析（2016年）进行更新。若研究报告了紧急剖宫产子宫切除术的发生率（定义为产后6周内因严重产科并发症行子宫切除术），则该研究符合纳入标准。使用Endnote数据管理软件进行标题和摘要筛选以及全文审查。在筛选的8775篇文章中，纳入了2015年后发表的26篇文章，使纳入研究总数达到154篇。按收入水平对感兴趣的结局进行亚组分析。
制表、整合与结果：荟萃分析纳入154项研究：在42个国家的17127499例分娩中，共进行了14409例紧急剖宫产子宫切除术。子宫切除术的总体合并发生率为每1000例分娩1.1例（95%CI 1.0-1.3）。在中低收入地区观察到的发生率最高（每1000例分娩3例，95%CI 2.5-3.5），在高收入地区观察到的发生率最低（每1000例分娩0.7例，95%CI 0.5-0.8）。最常见的适应证为胎盘病变（38.0%，95%CI 33.9-42.4）、宫缩乏力（27.0%，95%CI 24.6-29.5）和子宫破裂（21.2%，95%CI 17.8-25.0）。在中低收入国家，子宫破裂（44.5%，95%CI 36.6-52.7）是最常见的适应证；在高收入地区，胎盘病变（48.4%，95%CI 43.5-53.4）最常见。为预防子宫切除术，2706名妇女（17%）使用了宫缩剂：53.2%接受了缩宫素，44.6%接受了前列腺素，17.3%接受了麦角新碱。80.5%的妇女采取了预防子宫切除术的手术措施，最常见的是62.6%（95%CI 38.3-81.9）采用的压迫技术。最常见的并发症为发热（29.7%，95%CI 25.4-34.3）和血液学并发症（27.5%，95%CI 20.4-35.9）。每100例紧急剖宫产子宫切除术的总体孕产妇病死率为3.2%（95%CI 2.5-4.2），在中低收入地区更高（每100例紧急剖宫产子宫切除术11.2%，95%CI 8.9-14.1），在高收入地区更低（每100例紧急剖宫产子宫切除术1.0%，95%CI 0.6-1.6）。
紧急剖宫产子宫切除术的发生率在不同收入水平地区存在显著差异。低收入地区的妇女接受紧急剖宫产子宫切除术的风险更高，且与手术相关的发病率和死亡率也更高。鉴于剖宫产率的上升，紧急剖宫产子宫切除术的发生率可能会增加。
