| Emergency obstetric hysterectomy is a procedure that potentially preserves the life of pregnancy and the postpartum bleeding is the direct cause of its indication. It is an indispensable life saving tool for the management of intractable obstetric haemorrhage unresponsive to other treatment. Although obstetric hysterectomy is the most effective process to control obstetric haemorrhage, it also is described as a catastrophic procedure for the surgery ends a women's reproductive life. The available evidence showed that hysterectomy may impact the life quality of these women more or less after operation. To provide evidence for taking appropriate preventive mearsures and try to reduce the occurring of obstetric hysterectomy is an important problem. The objective is to analyze the relative high risk factors in occurring obstetric hysterectomy. The indications for emergency obstetric hysterectomy should be discussed seriously. These results will make clinicians know about variation of indications for emergency obstetric hysterectomy in order to cut down the incidence of obstetric hysterectomy effectly. The method of sampling survey is used to review 74 cases of the obstetric hysterectomy perform in the past 20 years (1987-2006) and make a retrospective study, The content is comprised of parity, the history of induced abortion or uterine-incision delivery, risk factors and type of postpartum hemorrhage, and operational indications. Comparison of reasons was made among different date including the era, rank of delivery hospital and the delivery manner. All the date come from the records in hospital. Statistical analysis was carried out using EXCEL software package to calculate constituent ratio and the results help us to analysis on the cause of 74 obstetrical bleeding cases treated by suing hysterectomy. Results are manifested:⑴The indications of obstetrical bleeding cases treated by suing hysterectomy are placenta factors(32.4%), uterus ruptures(4.1%), atony of uteres(24.3%), puerperal infection(29.7%) and DIC(9.5%).⑵Different type of postpartum hemorrhage have a different constituent ratio of reasons to perform obstetrical hysterectomy. The reasons of intrapartum hemorrhage are atony of uteres (45.0%),placenta factors (30.0%),DIC(17.5%),uterus ruptures (5.0%),puerperal infection (2.5%);The reasons of late postpartum hemorrhage are puerperal infection(61.8%),placenta factors (35.3%),uterus ruptures (2.9%)。⑶Through the compare of the constituent ratio, we can find that the differences are present between different ear, different delivery manners and different rank of delivery hospitals.①The reasons of obstetric hysterectomy between 1987 to 1996 are puerperal infection(53.8%),placenta factors (23.1%),uterus ruptures (15.4%),atony of uteres (7.7%);The reasons of obstetric hysterectomy between 1997 to 2006 are placenta factors (34.4%),atony of uteres (27.9%),puerperal infection (24.6%),DIC(11.5%), uterus ruptures (1.6%)。②The reasons of obstetric hysterectomy which are in vaginal delivery are:placenta factors (34.3%), atony of uteres (31.4%), DIC(17.1%), puerperal infection (11.4%), uterus ruptures (5.7%); The reasons of obstetric hysterectomy which are in cesarean section delivery are:puerperal infection (46.2%), placenta factors (30.8%), atony of uteres (17.9%), DIC(2.6%), uterus ruptures (2.6%)。③The reasons of obstetric hysterectomy are,in the first rank hospital:puerperal infection (50.0%),placenta factors (50.0%);in the second rank hospital:placenta factors (30.2%),atony of uteres (30.2%), puerperal infection (26.4%), DIC(9.4%), uterus ruptures (3.8%); in the third rank hospital:placenta factors (60.0%), atony of uteres (40.0%); in clinic:puerperal infection (66.7%), uterus ruptures (16.7%), DIC(16.7%); in home:placenta factors (50.0%), puerperal infection (25.0%), DIC(25.0%)。The Conclusions are:⑴The major indications of obstetrical bleeding cases treated by suing hysterectomy are placenta factors, uterus ruptures , atony of uteres, puerperal infection and DIC, especially placenta factors.⑵The major cause of intrapartum hemorrhage is atony of uteres and that of late postpartum hemorrhage is puerperal infection.⑶The sample drawing investigation is demonstrated that the constituent ratio of obstetrical emergency hysterectomy make a great change, the leading cause from 1987 to 1996 is puerperal infection and from 1997 to 2006 is placenta factors.⑷Comparing the causes of hysterectomy between the groups of uterine-incision delivery and vaginal delivery, the former is puerperal infection and the latter is placenta factors.⑸The proportion of obstetrical emergency hysterectomy is higher, which have a close relationship with patient's condition and antenatal care and the treatment of gestational complications.⑹There is a high proportion among the multiparas and superfoetations,⑺The valid path that we lower the obstetrical emergency hysterectomy ratio is to carry out perinatal care and discover high risk pregnancy in time, to perform birth control and reduce artificial abortion and induced labor , to grasp indications of uterine-incision delivery , to strictly forbid illegal midwifery and to improve technical leve and responsibility of medical staff. |
PDF Full Text Request