| Objective : To analyze the clinical data of patients with obstetric emergency hysterectomy in a retrospectively way,and obtain the related high-risk factors,clinical characteristics and prognosis of emergency obstetric hysterectomy,and then give the guidance to the clinical.Methods:Collect the clinical data of emergency hysterectomy patients in obstetrics department of our hospital from January 2013 to December 2018,including age,gestational week,history of pregnancy and childbirth,complications of pregnancy,presence of multiple pregnancy,and mode of delivery,amount of bleeding,surgical indications,surgical methods,surgical timing,postoperative complications and prognosis,etc.,and to make statistical analysis and conclusion.Results:(1)From January 2013 to December 2018,a total of 13,428 births were performed in the obstetric department of our hospital,of which 7101 were delivered by vagina,6327 were by cesarean section,and the cesarean rate was 47.12%.A total of64 patients underwent emergency hysterectomy.The incidence of emergency hysterectomy was 0.48%,of which 61 were removed during or after cesarean section,accounting for 0.96% of cesarean section.3 cases were hysterectomy after vaginal delivery,accounting for 0.04% of the delivery in the same period.The incidence of cesarean emergency hysterectomy was significantly higher than that of vaginal delivery,and the difference was statistically significant(P <0.05).(2)Among the 64 cases of emergency hysterectomy,50 cases were removed due to placental factors,accounting for 78%,including 46 cases of placenta implantation,accounting for 72%,2 cases of placenta previa,accounting for 3%,2 cases of placental abruption,accounting for 3%;8 cases of hysterectomy due to uterine atony,accounting for 13%,2 cases was hysterectomy due to DIC caused by amniotic fluid embolism,accounting for 3%,3 case was hysterectomy due to DIC caused by acute fatty liver,accounting for 5%,1 case was hysterectomy due to pregnancy and hemocytopenia,accounting for 2%.(3)In the past six years,there were 7462 multiparas,5966 primiparas,55 multiparas and9 primiparas in 64 cases of emergency hysterectomy.The emergency hysterectomy rate of multipara was 0.74%,and that of primipara was 0.15%.The difference was statistically significant(P < 0.05).(4)Of the 13,428 women,5,823 had a history of cesarean section,and 7,605 women denied a history of cesarean section.Of the 64 patients who underwent emergency hysterectomy,48 had a history of previous cesarean section,16 had no history of cesarean section,and the emergency hysterectomy rate of previous cesarean section was as high as 0.82%,the rate of emergency hysterectomy without a history of cesarean section was 0.21%.The rate of emergency hysterectomy with a history of cesarean section was greater than that without cesarean section.The difference was statistically significant(P <0.05).(5)Among 64 cases of emergency hysterectomy,41 cases were subtotal hysterectomy,accounting for 64%,23 cases were total hysterectomy,accounting for 36%.The mean age and amount of bleeding in the total hysterectomy group were 30.89 ± 5.50 years old,3496.49 ± 1309.71 ml,and those in the sub total hysterectomy group were 28.43± 4.79 years old,2785.71 ± 755.93 ml.There was no significant difference in age and amount of bleeding between the two groups(P > 0.05).(6)Of the 64 patients,51 were removed immediately during the operation,of which45 were removed due to placental factors,accounting for 88%,and 6 were non-placental factors,accounting for 12%;There were10 cases had hysterectomy after cesarean section,ncluding 4 cases of placenta factor,accounting for 40%,6 cases of non placenta factor,accounting for 60%;3 cases of hysterectomy after vaginal delivery,including 1 case of placenta factor,accounting for 33%,2 cases of non placenta factor,accounting for 67%.The proportion of hysterectomy due to placental factors during cesarean section was significantly higher than that due to non placental factors.The proportion of hysterectomy due to placental factors after cesarean section and vaginal delivery was significantly lower than that due to non placental factors(P< 0.05).Conclusions:(1)The incidence of emergency obstetric hysterectomy in our hospital was 0.48% from January 2013 to December 2018.The incidence of emergency obstetric hysterectomy is not only related to the economic development of the region,but also closely related to hospital level,cesarean section rate and other factors.(2)The history of cesarean section and the parturient are the high risk factors of emergency hysterectomy in obstetrics.Twin pregnancy is the high risk factor of hysterectomy due to uterine atony.The complications of pregnancy will increase the incidence of emergency hysterectomy.(3)Placental implantation has become the main indication of emergency hysterectomy.Uterine inertia is the second most important indication of emergency hysterectomy after placental implantation.(4)The choice of the operation mode of hysterectomy has nothing to do with the patient's age and the amount of bleeding during the operation.The choice of the specific method depends on the situation of the patient during the operation.(5)The emergency hysterectomy during cesarean section is often due to placental implantation,and the emergency hysterectomy after cesarean section or vaginal delivery is often due to non-placental factors.In a word,no matter placental implantation or uterine atony,we should strictly grasp the opportunity of hysterectomy and make a decision. |
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