Mansouri Ghazal, Karami Robati Fatemeh, Dehghani Azam, Golnarges Faezeh, Salehiniya Hamid, Alkatout Ibrahim, Allahqoli Leila
Department of Obstetrics and Gynecology, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman 76169-13555, Iran.
Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman 7616913555, Iran.
Medicina (Kaunas). 2025 Feb 20;61(3):371. doi: 10.3390/medicina61030371.
: Cesarean hysterectomy is a critical intervention often required to manage life-threatening postpartum hemorrhage (PPH) due to complications such as uterine atony, abnormal placental implantation, or traumatic rupture. Although lifesaving, the procedure is associated with significant risks and complications. This study investigates the causes and outcomes of cesarean hysterectomy, focusing on complications arising from the procedure. : A retrospective analysis was conducted on 82 women who underwent cesarean hysterectomy at Afzali Pour Hospital between 2018 and 2022. All patients were followed for 42 days post-surgery to evaluate outcomes and complications. Data were extracted from electronic medical records, encompassing demographic, obstetric, and clinical details, including age, body mass index, previous cesarean sections, indications for cesarean deliveries, causes of hysterectomy, and complications. The primary outcome was to determine the causes of cesarean hysterectomy, while the secondary outcome assessed the complications associated with the procedure. Stepwise logistic regression analysis was utilized to identify significant predictors of complications. : The study included 82 women who underwent cesarean hysterectomy. The mean age of the participants was 35.2 years (SD = 5.4), with a range from 24 to 48 years. The average BMI was 29.1 kg/m (SD = 4.3), with 45% of the women classified as overweight or obese (BMI ≥ 25). The majority of the patients (70%) had a history of two or more previous cesarean sections, and the most common indication for cesarean hysterectomy was abnormal placentation, including placenta accreta (58%). Uterine rupture was reported in 13% of the cases. In terms of complications, bladder injury was the most common, occurring in 33.33% of women, followed by fever (20%), ureteral injury (13.33%), and hematoma (8.89%). Stepwise logistic regression analysis revealed that higher BMI significantly increased the odds of the outcome (OR = 4.18, 95% CI: 1.66-10.51, = 0.002), and the number of previous cesarean sections was also a significant predictor (OR = 2.30, 95% CI: 1.17-4.53, = 0.016). : Placenta accreta and previa were the most frequent causes of cesarean hysterectomy, with bladder injury and fever being the most common complications. A higher number of previous cesareans and higher BMI significantly increase the likelihood of complications. Understanding these risk factors can improve patient management and surgical outcomes, highlighting the importance of careful monitoring and preoperative planning in women with a history of cesarean deliveries.
剖宫产子宫切除术是一种关键的干预措施，常用于处理因子宫收缩乏力、胎盘植入异常或创伤性破裂等并发症导致的危及生命的产后出血（PPH）。尽管该手术能挽救生命，但也伴随着重大风险和并发症。本研究调查剖宫产子宫切除术的原因和结果，重点关注该手术引发的并发症。
对2018年至2022年期间在阿夫扎利·普尔医院接受剖宫产子宫切除术的82名女性进行了回顾性分析。所有患者术后随访42天以评估结果和并发症。数据从电子病历中提取，包括人口统计学、产科和临床细节，如年龄、体重指数、既往剖宫产史、剖宫产指征、子宫切除原因及并发症。主要结果是确定剖宫产子宫切除术的原因，次要结果是评估与该手术相关的并发症。采用逐步逻辑回归分析来确定并发症的显著预测因素。
该研究纳入了82名接受剖宫产子宫切除术的女性。参与者的平均年龄为35.2岁（标准差 = 5.4），年龄范围为24至48岁。平均体重指数为29.1 kg/m（标准差 = 4.3），45% 的女性被归类为超重或肥胖（体重指数≥25）。大多数患者（70%）有两次或更多次既往剖宫产史，剖宫产子宫切除术最常见的指征是胎盘植入异常，包括胎盘植入（58%）。13% 的病例报告有子宫破裂。在并发症方面，膀胱损伤最为常见，发生在33.33% 的女性中，其次是发热（20%）、输尿管损伤（13.33%）和血肿（8.89%）。逐步逻辑回归分析显示，较高的体重指数显著增加了出现该结果的几率（比值比 = 4.18，95% 置信区间：1.66 - 10.51，P = 0.002），既往剖宫产次数也是一个显著的预测因素（比值比 = 2.30，95% 置信区间：1.17 - 4.53，P = 0.016）。
胎盘植入和前置胎盘是剖宫产子宫切除术最常见的原因，膀胱损伤和发热是最常见的并发症。既往剖宫产次数较多和体重指数较高会显著增加并发症的可能性。了解这些风险因素可改善患者管理和手术结果，凸显了对有剖宫产史的女性进行仔细监测和术前规划的重要性。
