产科子宫切除术的发生率和母儿预后

Morbidity and Maternal and Fetal Outcomes Associated with Obstetric Hysterectomy

目的:评估产科子宫切除术的适应证、高危因素、发生率、死亡率及围产儿预后。方法:回顾性研究深圳市宝安区妇幼保健院产科2005年1月1日-2011年12月31日期间所发生的子宫切除术,并将相关数据用SPSS13.0分析。结果:在研究期间分娩总数为50 330例,子宫切除共计33例,总发生率0.066%,经阴道产31 324例,切除子宫7例,发生率为0.02%,剖宫产19 006例,切除子宫26例,发生率为0.14%,剖宫产患者切除子宫的几率较顺产大。大部分患者年龄在31～35周岁(36.5%),为经产妇(75.8%),足月产(48.5%);病理性胎盘附着是产科子宫切除最主要风险因素(48.5%);常见的手术指征为病理性胎盘附着(48.5%)和宫缩乏力引起的产后出血(30.3%)。产妇死亡4例,死亡率12.1%。新生儿死亡1例,死亡率3%。结论:减少宫腔操作,降低剖宫产率是减少急诊产科子宫切除手术的可行办法;提高抢救水平,减少院外分娩可降低孕产妇和围产儿死亡率。

Objective： To evaluate the indication of obstetric hysterectomy, its risk factors, morbidity, mortality and outcome of perinatal. Methods：Retrospective study of all patients who under went obstetric hysterectomy was conducted from 1st January 2005 to 31st December 2011 at the Maternal and Child Health Hospital of Bao＇ an District in Shenzhen. Data was analyzed by computer software, SPSS version 13. 0. Results： During the study time period there were total 50 330 deliveries, and 33 cases of obstetric hysterectomy were identified, giving a frequency of 0. 066% deliveries. 7 were after 31 324 vaginal deliveries, an incidence of 0. 02%, 26 were after doing 19 006 cesarean sections,an incidence of 0. 14%. Cesarean sections cause more obstetric hysterectomy than vaginal deliveries. Most of patients were 31-35 years old （36. 5%） ,multiparae （75. 8%） ,delivered at term （48. 5%）. The commonest risk factor was morbidly adherent placenta（48. 5%）. The common indication for obstetric hysterectomy was morbidly adherent placenta（48. 5%） and atonie postpartum hemorrhage（30. 3%）. There were 4 maternal and 1 perinatal deaths, maternal mortality rate was 12. 1% and perinatal mortality rate was 3%. Conclusion：Reducing operation in uterine cavity and lowering cae- sarean section rate were good ways to reduce obstetric hysterectomy. It can reduce feto-maternal mortality to improve the rescue level and to lessen mismanaged labour.