Clinical Analysis Of 36 Cases Of Obstetric Emergency Hysterectomy

Objective:To analyse the risk factors and the main reasons of emergency hysterectomy in obstetrics.To investigate the selection of opportunity and methods,the prognosis and the influence of hysterectomy.In order to provide clinical basis for reducing the rate of obstetric emergency hysterectomy.Methods:We performed a retrospective analysis of 160 cases with postpartum hemorrhage more than 1000ml in obstetrics of Jinan maternity and child care hospital from July 2008 to June 2016.To perform disposal and statistical analysis of medical records such as medical history,laboratory examination,diagnosis and treatment.36 cases of emergency hysterectomy patients as observation group,the remaining 124 cases as control group.Comparison of the general condition of patients,maternal history,delivery history,abortion hi story,pregnancy complications,labor complications,quantity of blood loss and blood infusion,methods and opportunity of hysterectomy,and postoperative complications in two groups.Analysis of related high risk factors,clinical characteristics and prognosis of hysterectomy,etc.Results:(1)The patient' s general condition has no significant statistic difference between the two groups,which is comparable.(2)There were significant differences in patient's maternal history,abortion history,especially the history of cesarean section between two groups(P<0.05).The risk of hysterectomy,is higher in patients with history of cesarean section,multiple gestation history or abortion history.(3)These complications are closely related to obstetric emergency hysterectomy,such as,scarred uterus,placenta previa,placenta implantation,amniotic fluid embolism,uterine inert ia,hysterorrhex is,hemorrhagic shock,DIC,ect.The difference between the two groups was statistically significant(P<0.05);There were no statistically significant differences between the two groups(P>0.05)with or without these complications,such as hypertensive disorder complication pregnancy(HDCP),gestational diabetes mellitus(GDM),multiple abortions,polyhydramnios,fetal macrosomia,giant hysteromyoma,Hepatitis B carriers,Soft birth canal laceration,ect.(4)Placenta factors(64%)accounted for the primary cause of emergency hysterectomy,including placenta implantation(30.56%),placenta previa(25.00%),placenta abruption(8.33%).Followed by uterine inertia(13.89%)and amniotic fluid embolism(13.89%).(5)The rate of hysterectomy is difference with different delivery way,which contains cesarean section(80.56%)and vaginal delivery(19.44%).(6)19 cases underwent subtotal hysterectomy(52.78%).And 17 cases underwent total hysterectomy(47.22%).Emergency hysterectomy preferred subtotal hysterectomy.However,patients with amniotic fluid embolism or placenta previa merge placenta implanting should do total hysterectomy.(7)The volume of blood loss and blood infusion in hysterectomy group was significant different from the control group.Different delivery way brings different amount of postpartum hemorrhage.Among patients delivered by cesarean section,Blood loss greater than 3000ml in 26 cases,72.23%.patients by vaginal delivery,Blood loss greater than 3000ml in all 7cases.(8)There were no statistic differences in prognosis of pregnant&infant and perinatal outcome between two groups.Maternal death in 1 case,and perinatal death in 2 cases among hysterectomy group.Conclusions:(1)Placenta factors,uterine inertia and amniotic fluid embolism are the main indications of obstetric emergency hysterectomy.maternal age,multiple abortions,cesarean section,with scarred uterus,placenta previa,placenta implantation,placenta abruption,amniotic fluid embolism,hemorrhagic shock and DIC are all closely related to obstetric emergency hysterectomy.(2)Obstetric emergency hysterectomy is an important measure to save the life of acute critical maternal.We should reduce the rate of uterus resection when saving life,by grasping the surgical indication and opportunity.(3)The way of hysterectomy should depend on the patient' s situation.Though subtotal hysterectomy was suggested to be the first choice,the total hysterectomy should be done when amniotic fluid embolism,placenta implanting or uterine rupture followed infection happened.Welled perioperative management is the key to operation success and reducing of postoperative complication.(4)Encouraging fertility under the right age,avoiding multiple miscarriages,strengthen care and management during pregnant and delivery,reducing pregnancy complications,reducing the rate of primary cesarean section,promoting spontaneous labor,all of these are expected to reduce the emergency resection of uterus.