Clinical Analysis Of Hysterectomy In 41 Cases Of Obstertrict Emergency Summary

Objective: To analyze the incidence,risk factors and indications of hysterectomy in obstetric emergencies.To find the risk factors of hysterectomy in obstetric emergencies and measures to reduce the incidence of hysterectomy in obstetric emergencies.Methods: a retrospective analysis of 41 cases of hysterectomy of obstetric emergencies in the first affiliated hospital of Guangxi Medical University from March 1998 to March 2018(removing non-obstetric factors such as pregnancy and malignant tumor).The control group included 82 patients with postpartum hemorrhage >1000ml but not hysterectomy in obstetric emergency.Analyze and collect the general situation of the cases,past birth history,complications and postpartum hemorrhage to find the high-risk factors of hysterectomy in obstetric emergencies,and understand the indications and changes of hysterectomy in obstetric emergencies at different times.Results:1.From March 1998 to March 2018,the total number of births in our hospital was 40361,and the number of hysterectomy in obstetric emergencies was 42,accounting for 0.104 %(42/40361)of the total number of births in our hospital.2.Select high-risk factors such as age,preplacenta,placenta abruption,placenta implantation,uterine rupture,uterine myoma,twin pregnancy,DIC,amniotic fluid embolism,contractions,ITP,hypertensive disease during pregnancy,liver disease,etc..Single factor analysis for obstetric emergency hysterectomy.Among them,the anterior placenta,placenta implantation,scar uterus,amniotic fluid embolism,DIC,contractions,multiple pregnancies and childbirth,cesarean section,liver diseases(acute fatty liver,acute severe hepatitis),and severe postpartum hemorrhage are statistically significant(p>0.05).3.10 risk factors of hysterectomy for obstetric emergencies including preplacenta,placenta implantation,scar uterus,amniotic fluid embolism,DIC,contractions,multiple pregnancies and deliveries,cesarean section,liver diseases(acute fatty liver,acute severe hepatitis)and severe postpartum hemorrhage are included in multiple factors Regression model,multi-factor analysis shows: scar hysterectomy(OR = 0.192,95 % CI = 5.4-67.9),preplacenta(OR = 0.166,95 % CI = 3.8-71.5),placental implantation(OR =0.164,95 % CI = 3.9-69.3),severe postpartum hemorrhage(OR = 0.039,95 %,CI = 3.0-54.7),DIC(OR = 0.031,95 % CI = 0.5-18.3).4.The main surgical indications for hysterectomy in obstetrical emergencies in our hospital are: placental factors(51.12%),amniotic fluid embolization(19.51 %),DIC(7.32%),weak contractions(14.63 %),liver disease(4.88 %),and uterine incision infection(2.44 %).5.In the past 10 years,the proportion of placental factors in surgical indications for obstetric emergency hysterectomy in our hospital has increased from 11.11 % to 62.5 %,while the proportion of asthenia has decreased from44.44 % to 6.25 %.6.Comparison of urinary system,respiratory system,digestive system,blood system or multiple viscera injuries after hysterectomy in obstetric emergencies,and oral healing,including urinary system injuries,respiratory system injuries,digestive system injuries,MODS,and oral healing disorders.All have statistical significance(p<0.05).Conclusion: 1.Placental implantation,anterior placenta,scar uterus,severe postpartum hemorrhage and DIC are independent high risk factors for hysterectomy in obstetric emergencies.2.Women of childbearing age should use reasonable contraception to reduce unplanned pregnancies.3.Caesarean section can increase the risk of hysterectomy in obstetric emergencies.It is necessary to strictly grasp the indication of Caesarean section and reduce the rate of Caesarean section.4.The placenta factor replaced contractions and fatigue became the primary cause of hysterectomy in obstetrics emergency in our hospital.5.Obstetrical emergency hysterectomy urinary system injury and the incidence of surgical portal healing is high,should strengthen the protection of organs and postoperative care.