| 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.The rate of hysterectomy after vaginal diliver is very low,with the rising rate of caesarean delivery in the last 20 years, the increasing incidence of postpartum hemorrhage and obstetric hysterectomy in China were concerned.The major indications of cesarean hysterectomy are have been altered with the change of indications of cesarean diliver and the improved conservative methods.We focused on the variation of indications for emergency obstetric hysterectomy in order to cut down the incidence of obstetric hysterectomy effectly.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 woman's reproductive life. Most women undergoing obstetric hysterectomy were child-bearing period patients, the available evidence showed that hysterectomy may impact the life quality of these women more or less after operation. Hysterectomy can cause ovarian function decrease, and also adversely affect some women's sexuality. The indications for emergency obstetric hysterectomy should be discussed seriously. Hysterectomy in the peripartum period is often performed for life-threateningobstetric complications. Loss of future fertility, particularly in women having their first pregnancy means that all obstetric units should have clear guidelines in place to deal with this emergency and, if possible, apply techniques that allow preservation of the uterus. The decision should be made in time and in the right time. Losing the opportunity of hysterectomy cause disastrous consequences and high maternal morbidity. We also evaluated the hysterectomy after cardiopulmonary resuscitation (CPR). The purpose of this study was to review of all cases of emergency obstetric hysterectomy in 7 hospitals from 2000 to 2004 to assess the associated indications and high risk factor that were associared with improving outcomes of patients.Objective:l.To investigate the incidence of obstetric hysterectomy and its high risk factors in 7 hospitals in Guangzhou from January 2000 to December 2004. To analysis the indication and the right time for emergency obstetric hysterectomy. To discuss the methods which may be helpful to cut down the incidence of obstetric hysterectomy effectly.2.To evaluate the practice of hysterectomy after CPR under the situation that obstetric hemorrhagic shock lead to cardiac arrest.Materials and Methods:We retrospectively reviewed 80 obstetric emergency hysterectomy cases in Nanfang Hospital,Zhujiang Hospita.The second affiliated hospital of Sun Yat -sen University,The third affiliated hospital of Sun Yat -sen University,Guangzhou Second People's Hospital,Guangdong women and children hospital and health institute, Hexian Hospital from January 1st 2000 to December 31th 2004, not including the case of hysterectory because of tumor in the peripartum period led to hysterectomy.56 of80 obstetric hysterectomy were performed after caesarean sections and 24 after vaginal deliveries .56 cases of PPH(postpartum hemorrhage) after caesarean sections not undergoing obstetric hysterectomy were randomly carried out as control group. Medical information including :age, generational history, the gestation week, obstetric complications, present pregnant condition , some examination in hospital including blood routine and coagulation function, indications for caesarean section,the postpartum condition, bleeding reason, salvage process.therapeutic tool, indications for hysterectomy,type of hysterectomy (total, subtotal), outcomes and others related factors.Statistical analysis :SPSS 10.0 was used for statistical analysis .Date of normal distribution were expressed as mean and standard deviation, and T test was used for comparative analysis. Count data were expressed as frequency and rate, and chisquare test was used for analysis.The correlative factors were analyzed by binary logistic regression. To reduce omission errors, the significant difference was defined as P<0.15 in simplex-factor screening and P<0.05 in multifactor analysis.Resultl.The comparision between obstetric hemorrhage and delivery modalityA total of 65259 mothers delivered , including 30972 caesarean sections. The occurrence rate of postpartum hemorrhage after caesarean sections and vaginal deliveries 4.61%(1429/30972)and 3.31%(1136/34287) respectively. There were 80 cases received obstetric hysterectomy, resulting in an incidence of 0.12%. 56 (56/30972) obstetric hysterectomy were in caesarean sections and 12(12/34287) after vaginal deliveries. In the group of caesarean section the rate of postpartum hemorrhage and obstetric hysterectomy significantly higher than the group of vaginal delivery(P<0.05).2.The obstetric hysterectomy in vaginal deliveriesThere were 24 obstetric hysterectomy after vaginal deliveries for postpartum hemorrhage.lO of 24 mothers deliveried at home.12 of 24 mothers who deliveried in hospital were all survive after hysterectomy .The three major causes of obstetric hemorrhage were uterus rupture(10 cases), uterine inertia(6 cases) and Abnomaly placenta(5 cases). The study showed obstetric procedure was the main factor led to uterus rupture. Blood loss during the perioperative period varied between 1500 and 4750 ml, with an average of 3000 ml.DIC occurred inl2 cases. 3.Compare the groups with hysterectomy and without hysterectomy in caesarean under the obstetric hemorrhage.3.1 General conditionThere is no significant difference of mean age ,mean gestation week, rate of premature delivery, rate of primigravida,the frequency of artificial abortion and rate in labor before caesarean among the two groups.3.2 Compare the groups with abnormalities before caesarean sectionThere were multiple abnormalities before caesarean section in both groups. The abnormalities in this study were previous caesarean sections34.82 % (39/112) , coagulation disorders27.68% (31/112), placenta praevia 27.68% (31/112), abruptio placenta 16.07% (18/112), abnormal fetal positionl4.29 (16/112), polyhydramnios 14.29% (16/112) , gestational hypertension 12.5% (14/112) , large for date infant9.82%( 11/112), twin pregnancy8.93%( 10/112),ruptured uterus8.04% (9/112). The rates of abruptio placenta and coagulation disorders were significantly higher in the group with hysterectomy(P<0.05). The rates of ruptured uterus and placenta praevia are not significantly difference in both groups, but the grades are different. There are more placenta praevia grade 3 and complete rupture in the group of hysterectomy(16/18 vs 8/13;3/7vs 0/2,P<0.15).3.3 Compare the groups with abnormalities during the perioperative periodAbnormalities found during the perioperative period are placental implantation, uterine malformation , large intramural hysteromyoma ,multiple myomata and DIC in the two groups. Oxytocic agents are routinely used in PPH. Ligation of internal iliac arteries was used to control bleed in some of the case.The incidence of DIC is significantly higher in the group with hysterectomy (19/56 vs 1/56, P<0.01);Blood loss during the perioperative and in 24hr postpartum were greater in hysterectomy group( P<0.01).Units use oxytocic agents are more frequently in non hysterectomy group(46/56 vs 13/56,P |
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