高龄孕妇剖宫产产后出血危险因素分析

目的探讨高龄孕妇剖宫产产后出血的主要危险因素。方法回顾性分析2010年1月至2011年6月期间在北京民航总医院剖宫产分娩的623例高龄孕妇（年龄≥35岁）的临床资料,分为产后出血组（胎儿娩出后2h内出血量≥400ml或至胎儿娩出后24h内出血量≥500ml）和非产后出血组,对可能影响术后出血的因素进行单因素分析与Logistic回归分析。结果 623例高龄孕妇剖宫产产后出血52例,发生率为8.35%。单因素分析有妊娠高血压疾病、妊娠期糖尿病、流产病史、经产妇、巨大儿、宫缩乏力和前置胎盘7种指标与高龄孕妇产后出血相关。非条件多因素分析结果筛选出3个主要的危险因素：宫缩乏力、前置胎盘、妊娠高血压疾病。结论高龄孕妇剖宫产产后出血的发生率较高。宫缩乏力、前置胎盘、妊娠高血压疾病是高龄孕妇剖宫产发生产后出血的主要危险因素。     

中央性前置胎盘合并胎盘植入产后大出血的相关因素分析

目的 探讨中央性前置胎盘合并胎盘植入孕妇产后大出血的相关因素及预防措施。方法 收集2005年4月至2019年6月浙江大学医学院附属妇产科医院收治的355例中央性前置胎盘合并胎盘植入孕妇的临床资料,根据患者剖宫产术中及术后24 h内阴道出血量将患者分成产后大出血组（出血量≥2 000 mL）和对照组（出血量<2 000 mL）,回顾性分析两组患者的一般资料、合并产前出血、妊娠合并症并发症、子宫畸形、胎盘位于子宫位置、分娩孕周、术中情况和手术操作等与产后大出血的关系。结果 影响中央性前置胎盘合并胎盘植入孕妇发生产后大出血的相关因素单因素分析显示,既往剖宫产次数、胎盘位于前壁、周围脏器浸润、子宫动脉结扎术、宫腔填塞术可能与产后大出血的发生相关（P <0.05）。进一步多因素logistic回归分析发现,周围脏器浸润（OR=28.821, 95%CI:3.741～222.033, P=0.001）、胎盘位于子宫前壁（OR=1.704, 95%CI:1.013～2.866,P=0.044）是中央性前置胎盘合并胎盘植入孕妇发生产后大出血的独立危险因素;子宫动脉结扎术（OR=0.593,...     

宫缩剂不敏感宫缩乏力性产后出血的诊治

产后出血是分娩期主要并发症,发生率为4％～6％,是我国孕产妇死亡的四大原因之一.其中子宫收缩乏力是产后出血的主要原因,占产后出血的70％～75％. 1 宫缩剂不敏感的宫缩乏力性产后出血的诊断 在正常情况下,胎盘娩出后子宫肌纤维的收缩和缩复使胎盘剥离面内开放的血窦闭合,形成血栓而止血.故一切影响子宫正常收缩和缩复功能的因素均可引起产后出血.有宫缩乏力的危险因素并排除胎盘因素(主要是前置胎盘和胎盘粘连、植入和穿透)、产道损伤和凝血功能障碍,即可诊断为宫缩乏力性产后出血.     

产后流血和宫腔填塞纱布的重新评价

产后出血500毫升以上称产后流血。发生在产后24小时内称早期流血,24小时后发生的称晚期流血。与产后流血有关的病因包括宫缩乏力,子宫破裂、富颈和阴遭撕裂、会阴切开、胎盘滞留,凝血障碍和植入性胎盘。Weeks和Qtoole观察了22159例分娩者,有200例产后流血,75%归因于宫缩乏力,19%由于下产道撕裂,6%由于胎盘滞留。Beechan报道从1931     

宫腔塞纱阻止产后出血12例临床分析

目的探讨宫腔塞纱阻止产后出血治疗的可行性与安全性。方法2000年10月～2004年12个月自然分娩后宫缩乏力产后出血宫腔塞纱条3例，剖宫产术中宫缩乏力及前置胎盘、胎盘植入大出血宫腔塞纱条9例。结果宫腔塞纱阻止出血全部成功，产后月经2～12个月均恢复正常。结论宫腔塞纱阻止产后出血是可行且安全的。     

不同年代产后出血346例临床特点分析

目的 通过对我院产后出血的病例进行回顾性分析，比较不同年代产后出血病例特点的变化。方法 对1993～1995年、2002-2004年共346例产后出血病例分为前后3年两组进行回顾性对比分析，包括年龄、孕周、产次、分娩方式、产后出血原因、分娩前后血红蛋白（HB）和血球压积（HCV）变化等指标。结果 2002年-2004年产后出血发生率较1993年～1995年明显上升。后3年产妇年龄较前3年增加。剖宫产分别占两组产后出血病例的49．04％和51．24％。宫缩乏力仍然是导致产后出血的第一位原因（51．9％vs58．7％），胎盘因素有显著上升（14．1％VS20．7％）。产后出血产妇分娩前后血红蛋白下降值和血球压积下降值后3年明显低于前3年（P〈0．05）。6年间因产后出血行子宫切除7例，其中5例为胎盘因素。结论 宫缩乏力仍是产后出血的首要原因，胎盘因素导致的产后出血近年来有所增加，成为产后出血的第二位原因，并成为导致子宫切除的严重产后出血的主要原因。     

再次剖宫产高龄产妇产后出血危险因素分析

目的:分析再次剖宫产高龄产妇的产后出血(PPH)危险因素,为产后出血的防治提供参考。方法:回顾分析2013年1月至2017年12月在中国医科大学附属盛京医院再次剖宫产的1497例高龄产妇的临床资料。根据是否发生产后出血,将产妇分为产后出血组(131例)与非产后出血组(1366例),分析产妇的年龄、孕产史、胎盘等各类因素与产后出血的相关性,并通过多因素Logistic回归分析筛选出独立危险因素。结果:Logistic回归分析显示,胎盘附着位置(OR=2.15,95%CI为1.17～3.95,P=0.013)、前置胎盘(非前置胎盘:参考组;非完全性前置胎盘:OR=13.85,95%CI为6.22～30.84,P<0.001;完全性前置胎盘:OR=29.32,95%CI为16.32～52.67,P<0.001)和胎盘植入(OR=7.08,95%CI为3.60～13.92,P<0.001)为产后出血的独立危险因素。结论:胎盘附着位置、前置胎盘、胎盘植入为影响再次剖宫产的高龄产妇产后出血的独立危险因素。     

产时产后出血子宫切除15例临床分析

目的 分析产时、产后子宫切除的发生率、手术指征、并发症及经验教训。方法 采用回顾性资料分析方法，对我院1990年4月～2004年6月因产科出血切除子宫的15例临床资料整理分析。结果 14年中我院分娩总数11556例，15例行子宫切除术，发生率约为1．3‰。胎盘因素10例，其中胎盘植入8例，前置胎盘2例；产后宫缩乏力3例；羊水栓塞1例；子宫破裂1例。结论 产时产后出血，胎盘因素为子宫切除主要因素，子宫切除为产科出血救治的措施和手段。     

产后出血危险因素及高危评分系统临床价值研究

目的 探讨发生产后出血的危险因素,以及建立产后出血高危评分系统和风险预测方程的临床应用价值。方法 选择2008年12月至2009年12月在福建省妇幼保健院进行系统产前检查并住院分娩的212例产后出血患者作为病例组,采用1∶2病例对照研究方法选择同期住院分娩未发生产后出血的424例产妇作为对照组;采用单因素分析筛选产后出血高危因素。在全国产后出血防治协作组拟定“产后出血预测评分表”（简称“评分表”）基础上,用筛选出的高危因素建立较全面的“产后出血高危评分系统”（简称“评分系统”）。通过受试者工作特性（receiver–operating characteristics,ROC）曲线下面积（AUC）评价并比较评分表和评分系统工作效能。结果 产后出血发生率为3.07%,其中严重产后出血发生率为15.56%。产后出血危险因素有孕妇年龄、产次、人工流产史、孕早期体重指数（BMI）、产前宫底高度、双胎或多胎妊娠、产前血小板计数（PLT）、前置胎盘、妊娠期高血压疾病、妊娠合并子宫肌瘤、胎儿腹围、羊水过多、分娩方式、子宫切口延裂、产道裂伤、第一产程异常、第三产程延长、胎盘粘连或植入、新生儿体重。用评分系统评分,若总评分≥6分或产前评分≥4分者发生产后出血危险性明显增加。评分表预测产后出血的ROC曲线AUC为0.657,评分系统评估产后出血的AUC为0.805。产后出血风险预测方程为：Z=1-1/［1+exp(-3.216+0.482×产前评分+0.452×产时产后评分)］或Z=1-1/［1+exp(-3.187+0.469×总评分)］;严重产后出血风险预测方程为：Z=1-1/［1+exp(-3.715+0.146×总评分)］。结论　产后出血发生与孕妇及胎儿因素、妊娠并发症及合并症、产程等均密切相关。评分系统总评分≥6分者或产前评分≥4分者应纳入产后出血重点监护范围。评分系统与评分表相比有较强预测产后出血的效能。     

高危评分法预测前置胎盘的产后出血

目的 探讨前置胎盘患者发生产后出血的相关因素，寻求在产前评估产后出血的预测方法。方法 回顾性分析1996年1月～2000年12月5年间，在我院住院分娩的136例前置胎盘病例产前各相关因素及妊娠结局。结果 (1)前置胎盘的发生率为1．24％，其产后出血发生率为22．06％；(2)与前置胎盘产后出血量有关的因素有高龄产妇、2次以上流产史、剖宫产史、前壁的前置胎盘、完全性前置胎盘、有产前出血史、无产前检查、存在妊娠合并症或并发症；(3)以产前存在的与产后出血量有关的因素作为产后出血危险因素评分，若评分≥4分则可能发生严重产后出血。结论 (1)前置胎盘产后出血量与有高龄产妇、2次以上流产史、前次剖官产史、前置胎盘的分类、有产前出血史、无产前检查、存在妊娠合并症或并发症显著相关；(2)鉴于产前同时存在危险因素4项以上极易发生产后出血，提出用产前高危评分来预测产后出血情况。     

Risk factors for postpartum hemorrhage requiring transfusion in cesarean deliveries for Japanese twins: comparison with those for singletons

Objective

The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies.

Methods

We reviewed the obstetric records of all singleton and twin deliveries after 22?weeks’ gestation at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2011. Potential risk factors for transfusion due to hemorrhage after cesarean delivery were selected according to previous studies of postpartum hemorrhage or transfusion or both after delivery: maternal age, parity, previous cesarean deliveries, history of infertility therapies such as in vitro fertilization, gestational age at delivery, neonatal birth weight, placenta previa, uterine myoma ≥6?cm, hypertensive disorders, placental abruption, emergency cesarean deliveries and general anesthesia.

Results

Using multiple logistic regression, the independent risk factors for postpartum hemorrhage requiring transfusion in singleton pregnancies were preterm delivery [odds ratio (OR) 2.40, 95?% confidence interval (CI) 1.2–4.6, p?<?0.01], placenta previa (OR 8.08, 95?% CI 3.9–16, p?<?0.01) and placental abruption (OR 12.8, 95?% CI 2.3–76, p?<?0.01). In twin pregnancies, however, the independent risk factors for postpartum hemorrhage requiring transfusion were gestational age at ≥41?weeks (OR 8.20, 95?% CI 1.3–40, p?<?0.01) and hypertensive disorders (OR 5.45, 95?% CI 2.2–14, p?<?0.01).

Conclusions

The factors associated with postpartum hemorrhage requiring transfusion in cesarean deliveries of twins seemed to be different from those in singleton cesarean deliveries.     

Placenta previa: obstetric risk factors and pregnancy outcome

Objective: To determine the incidence, obstetric risk factors and perinatal outcome of placenta previa. Study design: All singleton deliveries at our institution between 1990 and 1998 complicated with placenta previa were compared with those without placenta previa. Results: Placenta previa complicated 0.38% ( n = 298) of all singleton deliveries ( n = 78 524). A back-step multiple logistic regression model found the following factors to be independently correlated with the occurrence of placenta previa: maternal age above 40 years (OR 3.1, 95% CI 2.0-4.9), infertility treatments (OR 3.1, 95% CI 1.8-5.6), a previous Cesarean section (OR 1.8, 95% CI 1.4-2.4), a history of habitual abortions (OR 1.3, 95% CI 1.3-2.7) and Jewish ethnicity (OR 1.3, 95% CI 1.1-1.8). Pregnancies complicated with placenta previa had significantly higher rates of second-trimester bleeding (OR 156.0, 95% CI 87.2-277.5), pathological presentations (OR 7.6, 95% CI 5.7-10.1), abruptio placentae (OR 13.1, 95% CI 8.2-20.7), congenital malformations (OR 2.6, 95% CI 1.5-4.2), perinatal mortality (OR 2.6, 95% CI 1.1-5.6), Cesarean delivery (OR 57.4, 95% CI 40.7-81.4), Apgar scores at 5 min lower than 7 (OR 4.4, 95% CI 2.3-8.3), placenta accreta (OR 3.6, 95% CI 1.1-9.9) postpartum hemorrhage (OR 3.8, 95% CI 1.2-10.5), postpartum anemia (OR 5.5, 95% CI 4.4-6.9) and delayed maternal and infant discharge from the hospital (OR 10.9, 95% CI 7.3-16.1) as compared to pregnancies without placenta previa. In a multivariable analysis investigating risk factors for perinatal mortality, the following were found to be independent significant factors: congenital malformations, placental abruption, pathological presentations and preterm delivery. In contrast, placenta previa and Cesarean section were found to be protective factors against the occurrence of perinatal mortality while controlling for confounders. Conclusion: Although an abnormal implantation per se was not an independent risk factor for perinatal mortality, placenta previa should be considered as a marker for possible obstetric complications. Hence, the detection of placenta previa should encourage a careful evaluation with timely delivery in order to reduce the associated maternal and perinatal complications.     

Placenta previa: obstetric risk factors and pregnancy outcome.

OBJECTIVE: To determine the incidence, obstetric risk factors and perinatal outcome of placenta previa. STUDY DESIGN: All singleton deliveries at our institution between 1990 and 1998 complicated with placenta previa were compared with those without placenta previa. RESULTS: Placenta previa complicated 0.38% (n = 298) of all singleton deliveries (n = 78 524). A back-step multiple logistic regression model found the following factors to be independently correlated with the occurrence of placenta previa: maternal age above 40 years (OR 3.1, 95% CI 2.0-4.9), infertility treatments (OR 3.1, 95% CI 1.8-5.6), a previous Cesarean section (OR 1.8, 95% CI 1.4-2.4), a history of habitual abortions (OR 1.3, 95% CI 1.3-2.7) and Jewish ethnicity (OR 1.3, 95% CI 1.1-1.8). Pregnancies complicated with placenta previa had significantly higher rates of second-trimester bleeding (OR 156.0, 95% CI 87.2-277.5), pathological presentations (OR 7.6, 95% CI 5.7-10.1), abruptio placentae (OR 13.1, 95% CI 8.2-20.7), congenital malformations (OR 2.6, 95% CI 1.5-4.2), perinatal mortality (OR 2.6, 95% CI 1.1-5.6), Cesarean delivery (OR 57.4, 95% CI 40.7-81.4), Apgar scores at 5 min lower than 7 (OR 4.4, 95% CI 2.3-8.3), placenta accreta (OR 3.6, 95% CI 1.1-9.9) postpartum hemorrhage (OR 3.8, 95% CI 1.2-10.5), postpartum anemia (OR 5.5, 95% CI 4.4-6.9) and delayed maternal and infant discharge from the hospital (OR 10.9, 95% CI 7.3-16.1) as compared to pregnancies without placenta previa. In a multivariable analysis investigating risk factors for perinatal mortality, the following were found to be independent significant factors: congenital malformations, placental abruption, pathological presentations and preterm delivery. In contrast, placenta previa and Cesarean section were found to be protective factors against the occurrence of perinatal mortality while controlling for confounders. CONCLUSION: Although an abnormal implantation per se was not an independent risk factor for perinatal mortality, placenta previa should be considered as a marker for possible obstetric complications. Hence, the detection of placenta previa should encourage a careful evaluation with timely delivery in order to reduce the associated maternal and perinatal complications.     

Vasa previa and postpartum hysterectomy in maternal Rh alloimmunization

Velamentous insertion of the cord, or vasa previa, is a malady where fetal vessels tranverse membranes ahead of the fetal part. The incidence of vasa previa is 1: 2000-3000 deliveries. Fetal mortality is over 50-75%. Early diagnosis is needed because these deliveries require emergency cesarean section; it is especially more common with placenta percreta, uterine atony and hemorrhage. Intravascular infusion of red blood cells (RBCs) into the fetus is one of the most successful means of in utero therapy for severe fetal anemia caused by RBC alloimmunization. We performed four fetal intrauterine intravascular transfusions (IVT) as therapy for severe fetal anemia. The patient underwent elective cesarean section. After delivery, profound uterine atony and vaginal hemorrhage were noted and the patient underwent hysterectomy. Pathological examination of the placenta and umbilical cord documented velamentous insertion of the cord. Before intrauterine IVT a detailed US examination is necessary to exclude vasa previa or placenta previa. Uterine atony may be result after a diagnosis of placenta previa or vasa previa. Intrauterine IVT is an irreplaceable diagnostic procedure in the treatment of severe fetal anemia.     

Identifying risk factors for peripartum cesarean hysterectomy. A population-based study

OBJECTIVE: To determine the incidence of, and obstetric risk factors for, emergency peripartum hysterectomy. STUDY DESIGN: A population-based study comparing all singleton deliveries between the years 1988 and 1999 that were complicated with peripartum hysterectomy to deliveries without this complication. Statistical analysis was performed with multiple logistic regression analysis. RESULTS: Emergency peripartum hysterectomy complicated 0.048% (n = 56) of deliveries in the study (n = 117,685). Independent risk factors for emergency peripartum hysterectomy from a backward, stepwise, multivariable logistic regression model were: uterine rupture (OR = 521.4, 95% CI 197.1-1379.7), placenta previa (OR = 8.2, 95% CI 2.2-31.0), postpartum hemorrhage (OR = 33.3, 95% CI 12.6-88.1), cervical tears (OR = 18.0, 95% CI 6.2-52.4), placenta accreta (OR = 13.2, 95% CI 3.5-50.0), second-trimester bleeding (OR = 9.5, 95% CI 2.3-40.1), previous cesarean section (OR = 6.9, 95% CI 3.7-12.8) and grand multiparity (> 5 deliveries) (OR = 3.4, 95% CI 1.8-6.3). Newborns delivered after peripartum hysterectomy had lower Apgar scores (< 7) at 1 and 5 minutes than did others (OR = 11.5, 95% CI 6.2-20.9 and OR = 27.4, 95% CI 11.2-67.4, respectively). In addition, higher rates of perinatal mortality were noted in the uterine hysterectomy vs. the comparison group (OR = 15.9, 95% CI 7.5-32.6). Affected women were more likely than the controls to receive packed-cell transfusions (OR = 457.7, 95% CI 199.2-1105.8) and had lower hemoglobin levels at discharge from the hospital (9.9 +/- 1.3 vs. 12.8 +/- 5.7, P < .001). CONCLUSION: Cesarean deliveries in patients with suspected placenta accreta, specifically those performed due to placenta previa in women with a previous uterine scar, should involve specially trained obstetricians. In addition, detailed informed consent about the possibility of emergency peripartum hysterectomy and its associated morbidity should be obtained.     

凶险性前置胎盘的妊娠结局及其与产后出血的高危因素分析

目的:探讨凶险性前置胎盘(PPP)的母婴结局及其与产后出血的高危因素。方法:回顾性分析2011年1月至2015年12月上海市第六人民医院住院分娩的前置胎盘患者181例,PPP患者72例(PPP组,其中发生产后出血34例,非产后出血38例),无剖宫产史妊娠的前置胎盘患者109例(非PPP组)。比较PPP组和非PPP组孕妇的年龄、孕周、孕次、产后出血率、输血率、胎盘植入率、子宫切除率、早产率、新生儿窒息率之间的差异;采用单因素与二项分类Logistic回归分析PPP组发生产后出血的高危因素。结果:PPP妊娠总占比0.44%;PPP组孕妇年龄、孕次、产次、前壁胎盘率、中央型前置胎盘率、胎盘粘连率、胎盘植入率、产后出血量、产后出血发生率、子宫切除率、输血率、早产率均明显高于非PPP组(P0.05),PPP组分娩孕周与新生儿体质量明显低于非PPP组(P0.05)。单因素分析显示:PPP患者产后出血组胎盘粘连率、胎盘植入率、中央型前置胎盘率、二级及以下医院剖宫产史占比、非产程中剖宫产史占比、前置胎盘史占比明显高于无产后出血组(P0.05);Logistic回归分析显示:胎盘粘连与中央型前置胎盘是PPP患者产后出血的独立危险因素(P0.05)。结论:产后出血与早产是PPP主要的不良妊娠结局;对于前次剖宫产史此次妊娠合并中央型前置胎盘或胎盘粘连患者,应警惕产后出血发生;降低剖宫产率是防止PPP发生与减少产后出血的关键因素。     

Peripartum hysterectomy between 2009 and 2010 in Sichuan,China

ObjectiveTo investigate the incidence and risk factors for peripartum hysterectomy (PH) in Sichuan, China.MethodsA population-based study was conducted using the obstetric inpatient records of women who gave birth at 1 of 8 hospitals between January 1, 2009, and December 31, 2010. Multivariate logistic regression analysis was used to identify independent risk factors for PH.ResultsDuring the study period, 64 cases of PH occurred among 34 014 deliveries (0.2%); abnormal placentation and uterine atony were the major indications for surgery. Several factors significantly increased the risk of PH among the study population: placenta previa (adjusted odds ratio [AOR] 10.0; 95% confidence interval [CI], 5.7–17.7), uterine atony (AOR 7.4; 95% CI, 4.3–12.8), repeat cesarean delivery (AOR 3.0; 95% CI, 1.2–7.7), low birth weight (AOR 2.6; 95% CI, 1.5–4.6), and multiparity (AOR 2.4; 95% CI, 1.3–4.4). By contrast, multiple gestation, primary cesarean delivery, placental abruption, leiomyoma, pre-eclampsia, eclampsia, and diabetes mellitus did not significantly increase the risk of PH.ConclusionPlacenta previa, uterine atony, repeat cesarean delivery, low birth weight, and multiparity were risk factors for PH among the study population.     

Application of uterine compression suture in association with intrauterine balloon tamponade ('uterine sandwich') for postpartum hemorrhage

We evaluated in a prospective observational study the use of a 'uterine sandwich' technique (uterine compression sutures in association with intrauterine tamponade) in women who had had unsuccessful medical treatment for postpartum hemorrhage. Ten of the 11 patients had cesarean sections (complicated by placenta previa and uterine atony) and one had a normal delivery. The median estimated blood loss and units of blood transfused were 1500ml (range 750-4000ml) and two units (range 0-9), respectively. B-Lynch sutures were placed in two patients and Hayman's modification was used in nine. Bakri balloon tamponade was in place for a median of 22 hours (range 17-27 hours), while the median volume infused in the balloon was 300ml (range 150-350ml). The combined technique was successful in avoiding hysterectomy in all cases, and there was no documented postpartum morbidity. This is a simple and quick surgical technique that can be used to treat atonic postpartum hemorrhage, particularly in conjunction with placenta previa.     

难治性产科出血时子宫切除术和子宫动脉栓塞术的临床分析

目的探讨产科急性出血性疾病治疗过程中进行子宫切除术和动脉栓塞术的临床特点以及选择时机。方法回顾性分析35例产科出血因素行子宫切除或者动脉栓塞病例的临床资料。结果16例子宫切除的患者中,胎盘因素10例,占62.5%（前置胎盘/胎盘植入7例,胎盘早剥伴有凝血功能障碍3例）,子宫异常4例（子宫收缩乏力2例、子宫切口延裂致阔韧带血肿和子宫破裂各1例）占25%;羊水栓塞致DIC后切除子宫2例占12.5%。19例行子宫动脉栓塞术中,前置胎盘3例,占15.8%,子宫收缩异常13例（原发性宫缩乏力产程中剖宫产4例、双胎4例,急产产后出血2例,巨大儿1例,巨大子宫肌瘤2例）占68.4%,剖宫产并发症3例（子宫切口延裂致阔韧带血肿和子宫动脉瘤各1例,剖宫产术后晚期产后出血1例）占15.8%,其中2例栓塞失败,分别行子宫切除术和开腹探查血肿清除术。子宫切除术平均出血量（4 593±2 727）ml,子宫动脉栓塞术时平均出血量（2 601±904）ml,两组比较差异有统计学意义（P〈0.05）。子宫切除组有11例出现了DIC表现占68.7%。行子宫动脉栓塞术时发生DIC1例,占10.5%,差异有统计学意义（P〈0.05）。结论二者均为治疗产后出血的有效手段,但是栓塞术作为保守治疗可以保留生育功能,对于改善患者的预后具有重要的意义,要求尽早采用,一旦发生了严重的DIC和休克,则失去了机会。而保守治疗不能短时间见效,应果断行子宫切除术。     

Indication of emergency peripartum hysterectomy: review of 17 cases

OBJECTIVES: The objectives were to determine the incidence, indications, associated risk factors and complications with emergency peripartum hysterectomy at King Abdulaziz University Hospital, Saudi Arabia. METHODS: This is a retrospective analysis of 17 cases of emergency peripartum hysterectomy done from January 1, 1991 to December 31, 2002. RESULTS: Seventeen patients of emergency peripartum hysterectomy were identified among 34,379 deliveries and the incidence rate was 0.5 per 1,000. Uterine atony 11 (64.7%, 9 without previa and 2 with previa) and followed by morbid adherent placenta with previa 6 (35.3%, 1 complete placenta accreta and 5 partial adherent placenta) was the most common indication of hysterectomy. Of the atonic group, 3 were primigravidae, 2 of 3 induced and 1 placenta previa. In morbid adherent placenta group the gravidity, previous abortions and prior cesarean deliveries were higher compared to the atonic group and were statistically significant. Conservative surgery performed in 6 (35.3%) patients before proceeding to hysterectomies, 3 (17.7%) patients had uterine artery ligation and 3 (17.7%) internal iliac ligation. Eight (47.1%) hysterectomies were subtotal. Nine (53%) patients developed disseminated intravascular coagulopathy (DIC) and one case (6%) had bilateral ureteric ligation and bladder injury. No maternal deaths occurred. CONCLUSION: Uterine atony still is the leading cause of primary postpartum hemorrhage and the main indications of emergency peripartum hysterectomy. The combination of high parity, cesarean section, prior cesarean delivery and current placenta previa were identified as risk factors, and should alert the obstetrician that an emergency peripartum hysterectomy may needed. Although no maternal mortality occurred morbidity remained high.