围生期急诊子宫切除:荷兰的一项前瞻性研究

作     者：Kwee A Bots M.L Visser G.H.A Bruinse H.W 朱磊 

作者机构：University Medical Centre Utrecht Location WKZ Department of Obstetrics and Gynaecology Lundlaan 6 3584 EA Utrecht Netherlands 

出 版 物：《世界核心医学期刊文摘（妇产科学分册）》 (Core Journal in Obstetrics/Gynecology)

年 卷 期：2006年第2卷第5期

页      面：16-16页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

主　　题：子宫切除 围生期 剖腹术 胎盘植入 手术指征 尿路损伤 子宫收缩乏力 分娩情况 并发症发病率 重症监 

摘      要：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.