产科急症子宫切除术48例临床分析

目的探讨降低产科急症子宫切除术发生率的措施。方法青岛市第八人民医院产科20年间分娩总数50526例,回顾分析其中48例急症子宫切除术病例的临床资料。结果行产科急症子宫切除术的病例占分娩总数的0.095%(48/50526),其中阴道分娩11例,剖宫产37例。手术指征为:胎盘因素27例,占56.25%;宫缩乏力14例,占29.17%;子宫破裂4例,占8.33%;凝血功能障碍3例,占6.25%。其中经产妇子宫切除中胎盘因素最为多见(69.70%,23/33),而初产妇中宫缩乏力占主要因素(60.00%,9/15)。有74.09%(20/27)的胎盘异常患者有前次剖宫产或子宫手术史。结论胎盘因素是导致产科急症子宫切除术的主要危险因素。积极预防胎盘异常种植的发生,可以有效地降低产科子宫切除率。     

产科急症子宫切除34例临床分析

目的探讨如何降低产科急症子宫切除发生率。方法回顾性分析15年间共34例产科急症子宫切除的临床资料。结果剖宫产分娩后子宫切除率是阴道分娩的5．2倍，产科急症子宫切除因素以宫缩乏力及胎盘因素居首位。结论要降低产科子宫切除的发生率，关键在于提高妇产科医务人员的专业技术水平，加强围产期保健，严格掌握剖宫产指征，降低剖宫产率，加大计划生育知识宣传。     

产科子宫切除28例临床分析

目的 :探讨产科子宫切除的发生率、指征、术式及分娩方式。方法 :对 2 8例作了子宫切除的孕产妇进行回顾性分析。结果 :产科子宫切除发生率的高低与产前保健预防、产时产后并发症的处治水平密切相关 ;必须严格掌握手术指征 ,适时实施手术 ;剖宫产子宫切除发生率高于阴道分娩子宫切除。结论 :防治产科的严重并发症、降低剖宫产率可减少产科子宫切除的发生     

产科急症子宫切除48例临床分析

目的：为探讨产科急症子宫切除的发生率、原因、手术指征和时机等因素，分析产科子宫切除的高危因素，探讨降低子宫切除率的可行措施。方法：回顾性分析我院1994年1月至2013年12月由于产科急症行子宫切除48例临床资料。结果：48例产科急症子宫切除术指征为不可控制的子宫出血，胎盘因素占首位。子宫切除是抢救产科出血，挽救孕产妇生命的一项重要且有效的措施和手段吲。结论：孕产次、病理妊娠及分娩方式与产科急症子宫切除密切相关。     

产科急症子宫切除41例临床分析

目的 :探讨产科急症子宫切除的临床情况。方法 :回顾性分析 10年间 4 1例产科急症子宫切除病例。结果 :4 1例产科急症子宫切除术指征为子宫大出血 ,其中胎盘因素占首位 (2 5例 ,4 5 .37% ) ,治愈率 97.5 6 % ,围生儿死亡率18.6 1%。结论 :子宫切除是抢救产科大出血 ,挽救产妇生命的一项重要且有效的措施     

产科急症子宫切除术75例临床分析

我院1963～1989年间因产科急症行子宫切除75例,发生率为0.14％,其中剖宫产并子宫切除57例,占剖宫产术的0.61％;阴道分娩后子宫切除18例,占阴道分娩的0.01％。75例子宫切除指征:胎盘因素居第1位,共40例,其中胎盘植入17例,胎盘早剥14例,前置胎盘9例。子宫破裂居第2位,共25例,其中子宫疤痕破裂11例。子宫肌瘤居第3位,共4例。75例中全宫切除15例,次全切除60例。本组存活新生儿30例,宫内死胎、死产及新生儿死亡45例,因产儿死亡率600‰,无产妇死亡。作者认为:人工流产及剖宫产是发生前置胎盘及胎盘植入的因素,要降低产科子宫切除的发生率,必须做好计划生育工作,正确掌握剖宫产指征,提高剖宫产技术,尽量减少胎盘早剥、子宫破裂的发生。     

产科子宫切除19例临床分析

目的：探讨产科子宫切除的发生率、指征、术式及分娩方式。方法：对19例做了子宫切除的患者进行了回顾性的分析。结果：剖宫产术中子宫切除发生率明显高于阴道分娩子宫切除,其中胎盘因素占首位（8例,42．1％）。结论：子宫切除是抢救产科大出血,挽救产妇生命的重要措施．     

产科临床中的子宫切除术

目的 分析比较选择性与急症子宫切除术在产科中的应用。方法 回顾性分析30年间36例行产科子宫切除术的病例。结果 33207例产妇中有26例实施了产科急症子宫切除术,10例实施了选择性子宫切除术,胎盘因素是产科急症子宫切除术的主要指征,产科子宫切除术患者的围生儿病死率为179.5‰。结论 子宫切除术是一项抢救产科急诊危重出血患者生命的重要措施,对于产前合并妇科良性或恶性肿瘤及有异常子宫出血的产妇亦为安全有效的治疗手段。     

围生期子宫切除70例临床分析

目的:对围生期子宫切除术及其相关因素进行分析,探讨如何降低围生期子宫切除的发生率。方法:对2004年5月至2011年5月重庆医科大学附属第一医院产科行子宫切除术的70例患者的临床资料进行回顾性分析。通过非条件Logistic回归分析筛选出与围生期子宫切除相关的主要危险因素。结果:围生期子宫切除占分娩总数的0.33%,其中剖宫产子宫切除66例(94.3%),阴道分娩4例(5.7%)。子宫次全切除术53例,全子宫切除术17例。围生期子宫切除的主要手术指征为:胎盘因素(47.1%)、宫缩乏力(22.9%)、子宫切口感染(12.9%)。多因素分析显示:宫缩乏力(OR=873.432)、胎盘植入(OR=96.258)、前置胎盘(OR=75.293)、剖宫产史(OR=17.587)、子宫切口感染(OR=3.906)、胎盘早剥(OR=2.857)是围生期子宫切除的危险因素。结论:围生期子宫切除术是治疗重度产后出血的有效措施之一,正确掌握剖宫产指征,把握产后出血切除子宫的时机,可以有效降低围生期子宫切除的发生率。     

50例产科子宫切除术临床分析

目的:通过对50例产科子宫切除术的临床分析,了解产科子宫切除的原因。方法:回顾统计1995年至2010年在我院产科分娩的产妇资料,用x2检验数据。结果:在我院产科分娩45681例产妇中,阴道分娩切除子宫8例,占阴道分娩的0.025%,占分娩总数的0.018%;剖宫产切除子宫42例,占剖宫产的0.304%,占分娩总数的0.092%;46例次全宫切除,4例全子宫切除。产科子宫切除50例中,首次妊娠者15例(占30%),多次妊娠者35例(占70%);35例多次妊娠产妇中,有人工流产史和剖宫史的24例,占子宫切除总数的48%,多次妊娠的68.57%。胎盘因素如前置胎盘、胎盘粘连等是产科切除子宫中胎盘方面的主要因素,占据产科切除因素的66%。结论:子宫切除术可以有效抢救紧急出血的危重产妇,但会对女性造成身心伤害,产前采取必要的措施减少子宫切除术因素的发生更加重要。     

Obstetrical hysterectomy

OBJECTIVE: Obstetrical hysterectomy still remains life saving operation. The aim of study was to determinate the frequency, indications and complications after the operation in the hospital in Zielona Góra, Poland. MATERIALS AND METHODS: A retrospective review based on hospital data of 36 patients undergoing obstetrical hysterectomy over the period of 11 years was undertaken. RESULTS: The incidence of obstetrical hysterectomy during 1990-2001 et the Department of Obstetrics and Gynaecology in the district hospital in Zielona Góra was 1: 593 deliveries. Post partum hysterectomy occurred in 0.021% of normal deliveries and 1.03% of cesarean sections. The most common indications were placenta increta and placenta accreta /61.1%/, followed by uterine atony /13.8%/ and rupture of the uterus /11.1%. The most frequent complications were shock and lesion of the urinary bladder/both 5.6%/. The maternal mortality was 2.8%. CONCLUSIONS: 1. The most common indications for the obstetrical hysterectomy are: placenta's pathologies; uterine atony and rupture of the uterus. 2. Obstetrical hysterectomy is connected with high risk of complications and maternal mortality.     

Surgical management of peripartum hemorrhage: a retrospective study

OBJECTIVE: Peripartum haemorrhage is an obstetrical emergency and requests a life saving procedure. The purpose of this study is to describe our experience with the surgical management of peripartum haemorrhage. PATIENTS AND METHODS: We performed a retrospective study including 16 patients who necessitated a surgical management of peripartum haemorrhage (artery ligations, uterine compression and/or emergency peripartum hysterectomy) between 1985 and 2007. RESULTS: The incidence of surgical management of peripartum haemorrhage was 0.047%. Conservative surgical management consisted in uterine compression sutures in three cases. Artery ligations were performed without success in seven patients; only one case of isolated utero-ovarian artery ligations was effective. An emergency peripartum hysterectomy was necessary in 12 cases. Uterine atony was the principal etiologic factor (43.8% of cases). There were no significant perioperative complications. No maternal death was reported. DISCUSSION AND CONCLUSION: In cases of non life-saving procedure, medical treatment and uterine arteries embolisation are often sufficient. Uterine compression suturing techniques are interesting alternatives and uterine arteries ligations can always be performed before hysterectomy. In cases of failure of conservative treatment, the emergency peripartum hysterectomy must be performed. Then, the choice concerning the surgical technique for the management of peripartum haemorrhage may be adapted to the patient, the centre and the obstetrical team.     

Emergency peripartum hysterectomy: A prospective study in The Netherlands

OBJECTIVE: To determine the incidence, indication, association with caesarean section (CS) and outcome of emergency peripartum hysterectomy (EPH) in The Netherlands. STUDY DESIGN: All 100 Dutch obstetric departments were asked to participate in a prospective nationwide registration of EPH between 1 April 2002 and 1 April 2003. For every case, a form with questions about obstetrical history, current pregnancy and delivery, maternal and neonatal outcome was completed. RESULTS: Eighty-nine (89%) hospitals participated and registered in total 48 EPH. The estimated incidence of EPH is 0.33/1000 births. The main indication for EPH was placenta accreta (50%), followed by uterine atony (27%). There were two maternal deaths (4%). Severe maternal morbidity included: urinary tract injury 15%, relaparotomy 25%, transfusion >10 units red blood cells 67%, intensive care admission 77%. Both previous CS and CS in the index pregnancy were associated with a significant increased risk of EPH. The number of previous CS was related to an increased risk of placenta accreta, from 0.19% for one previous CS to 9.1% for four or more previous CS. CONCLUSION: Emergency peripartum hysterectomy is associated with a high incidence of maternal morbidity and a case fatality rate of 4%. It is significantly related to CS in index or previous pregnancy. Placenta accreta is the most common indication to perform a peripartum hysterectomy.     

Emergency peripartum hysterectomy in a teaching hospital in Eastern Taiwan.

This study aims to review the incidence, indications, risk factors and complications associated with emergency peripartum hysterectomy in a teaching hospital. We reviewed records of patients undertaking emergency peripartum hysterectomy performed at our institution from 1998 to 2004. Emergency peripartum hysterectomy was defined as one performed for haemorrhage unresponsive to other treatments <24 h after delivery. Eight cases of emergency peripartum hysterectomy were performed. The rate of peripartum hysterectomy was 0.25%. The main indications for hysterectomy were uterine atony and abnormal placentation. No maternal death occurred. Use of peripartum hysterectomy may become necessary in managing obstetrical haemorrhage refractory to other measures.     

Obstetrical complications in gestational carrier pregnancies

OBJECTIVE: To report two cases of severe obstetrical complications in gestational carrier pregnancies and to review our clinical experience and compare our results with those reported in the literature. DESIGN: Retrospective analysis. SETTING: A university IVF program. PATIENT(S): Women without a functioning uterus or those whose pregnancy would exacerbate a medical condition were enrolled in the gestational carrier pregnancy program. INTERVENTION(S): IVF cycles using oocytes from genetic mothers (or oocyte donors) were performed, with ET to gestational carriers. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates, obstetrical complications, and neonatal outcomes. RESULT(S): Ten couples underwent a total of 13 cycles using gestational carriers. A clinical pregnancy rate of 69% (9/13) was achieved. An intrapartum hysterectomy and a late puerperal hysterectomy were required because of severe obstetrical complications. The late puerperal hysterectomy was performed for placenta accreta in a triplet gestation. This carrier sustained multiple cerebral infarcts and blindness. One triplet infant died secondary to a hypoplastic left ventricle and complications of prematurity. A second gestational carrier with a singleton gestation underwent a hysterectomy for a uterine rupture, and the infant has cerebral palsy. CONCLUSION(S): The past medical and obstetrical histories of potential gestational carriers must be closely scrutinized, and candidates must be thoroughly counseled about the potential risks involved in the procedure.     

Uterine rupture and its complications in the Netherlands: a prospective study

OBJECTIVE: To determine maternal and perinatal morbidity and mortality after uterine rupture in the Netherlands. STUDY DESIGN: All 100 Dutch obstetric departments were asked to participate in a prospective nationwide registration of uterine rupture between 1st April 2002 and 1st April 2003. For every case, a questionnaire about obstetrical history, current pregnancy and delivery, maternal and neonatal outcome was completed. RESULTS: Eighty-nine percent of all hospitals in the Netherlands participated. Ninety-eight uterine ruptures were registered; 95 after a previous caesarean section (CS) of which 91 occurred during a trial of labour. The fetus was extruded in the abdominal cavity completely in 18 cases and partially in 13 cases. Major complications due to uterine rupture were: perinatal death (n=11, from 94 cases with a viable fetus, 11.7%) and hysterectomy (n=4, 4.1%). CONCLUSION: These severe complications, perinatal death and hysterectomy, have to be an issue when counselling women on an elective CS and women with a history of a CS on the route of delivery.     

Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage

Objectives

The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD).

Study design

This prospective study from 2004 to 2007 was carried out in three Dublin maternity hospitals. Women were identified as having MOH if they received ≥5 units of red cell concentrate (RCC) acutely. Risk factors for hysterectomy or end organ dysfunction were calculated using logistic regression.

Results

One hundred and seventeen cases of MOH in 93,291 deliveries were identified (1.25/1000). The predominant cause was uterine atony. Haemostasis was achieved with medical therapy alone in 15% of cases. The hydrostatic balloon and the B-Lynch suture arrested bleeding in 75% and 40% of cases utilised respectively. Hysterectomy was required to arrest bleeding in 24% of women and 16% of women developed end organ dysfunction (11 had both). There was one maternal death. Independent risk factors for hysterectomy included the number of previous caesarean sections (OR 3.28, 95% CI 1.95-5.5), placenta praevia (OR 13.5, 95% CI 7.7-184), placenta accreta (OR 37.7, 95% CI 7.7-184), uterine rupture (OR 7.25, 95% CI 1.25-42) and the number of units of RCC transfused (OR 1.31, 95% CI 1.13-1.5). Independent risk factors for end organ dysfunction (EOD) were placenta accreta (OR 5, 95% CI 1.5-16.5), uterine rupture (OR 13.86, 95% CI 2.32-82), the number of RCC transfused (OR 1.31, 95% CI 1.13-1.5) and the minimum haematocrit recorded (OR 5.53, 95% CI 1.7-18).

Conclusions

MOH is complicated by hysterectomy in 24% and end organ dysfunction in 16% of cases. The risk of peripartum hysterectomy is increased with the number of previous caesarean sections, the aetiology of the bleed, namely placenta praevia/accreta or uterine rupture and the volume of blood transfused. Critically, failure to maintain optimal haematocrit during the acute event was associated with end organ dysfunction.     

子宫腺肌症患者子宫次全切除术后的危险性探讨

目的 :探讨子宫腺肌症患者子宫次全切除术后的危险性 ,为临床子宫腺肌症患者手术方式的选择提供指导。方法 :对子宫腺肌症患者行子宫次全切除术标本的子宫体下切缘进行常规病理组织学检查。结果 :子宫体下切缘子宫内膜异位病灶 (切缘阳性 )的发生率为 12 %。切缘阳性子宫腺肌症患者的子宫肌层最大厚度、临床症状以及是否合并子宫内膜异位症与切缘阴性的子宫腺肌症患者差异无显著性 (P >0 .0 5)。但切缘阳性子宫腺肌症患者的宫体纵形长度明显小于切缘阴性者 (P <0 .0 5)。结论 :子宫腺肌症患者的病程较长 ,病变弥漫、痛经明显且时间较长、合并子宫内膜异位症可能是子宫体下切缘阳性的高危因素 ,手术时切口过高是子宫体下切缘阳性的直接因素。子宫腺肌症患者如年龄较大同时存在高危因素 ,则应行全子宫切除术 ,如行子宫次全切除术 ,切口位置应尽量低 ,而且应对子宫体下切缘行病理组织学检查