Clark S L, Yeh S Y, Phelan J P, Bruce S, Paul R H
Obstet Gynecol. 1984 Sep;64(3):376-80.
From 1978 to 1982, 70 cases of emergency hysterectomy for obstetric hemorrhage were performed at Los Angeles County/University of Southern California Women's Hospital. Sixty hysterectomies followed cesarean section, and ten were performed for hemorrhage after vaginal delivery. The most common indication for hysterectomy was atony (43%) followed by placenta accreta (30%), uterine rupture (13%), extension of a low transverse incision (10%), and leiomyomata preventing uterine closure and hemostasis (4%). Hysterectomies performed for atony had a significant association with the following factors when compared to hysterectomies performed for other indications: 1) amnionitis, 2) cesarean section for labor arrest, 3) oxytocin augmentation of labor, 4) MgSO4 infusion, and 5) fetal weight. Fifty-seven percent of hysterectomies performed for placenta accreta were associated with a previous cesarean section. During the study period, 53% of all patients presenting at term with both a placenta previa and one or more previous cesarean sections, subsequently underwent hysterectomy for placenta accreta. Even with a broad inclusion of risk factors, only 74% of patients developing a hemorrhagic complication leading to hysterectomy can be identified before delivery.
1978年至1982年期间，洛杉矶县/南加州大学妇女医院对70例因产科出血而行急诊子宫切除术的患者进行了手术。其中60例子宫切除术是在剖宫产术后进行的，10例是在阴道分娩后因出血而进行的。子宫切除术最常见的指征是宫缩乏力（43%），其次是胎盘植入（30%）、子宫破裂（13%）、低位横切口延长（10%）以及子宫肌瘤妨碍子宫闭合和止血（4%）。与因其他指征进行的子宫切除术相比，因宫缩乏力进行的子宫切除术与以下因素显著相关：1）羊膜炎；2）因产程停滞而行剖宫产；3）催产素引产；4）硫酸镁输注；5）胎儿体重。因胎盘植入进行的子宫切除术中，57%与既往剖宫产有关。在研究期间，所有足月合并前置胎盘且有一次或多次既往剖宫产史的患者中，53%随后因胎盘植入而行子宫切除术。即使广泛纳入危险因素，在分娩前也只能识别出74%会发生导致子宫切除术的出血并发症的患者。
