Clinical analysis of 46 cases on emergency hysterectomy for postpartum hemorrhage.

doi:10.3877/cma.j.issn.2095-3259.2015.02.013

Abstract

Abstract:

Objective

To explore the risk factors and the time of hysterectomy for intractable postpartum hemorrhage.

Methods

A retrospective analysis was performed on 46 cases of emergency hysterectomy for postpartum hemorrhage, who were admitted to our hospital between January 2010 and December 2014.

Results

During five years, there were total 56436 delivery cases and 582 cases of postpartum hemorrhage in our hospital. The incidence rate of postpartum hemorrhage was 1.03%. 46 cases were processed emergency hysterectomy due to inefficient conservative theatments. The causes of postpartum hemorrhage incuded placenta factors (43.48%, 20/46), uterme atony(36.96%, 17/47), uterme atony with placenta factors (10.87%, 5/46), amnionic fluid embolism(4.35%, 2/46), and late postpartum hemorrhage(4.35%, 2/46). Range of blood loss was 1 500~4 000 ml. The average of blood loss was 2855±500 ml. All of 46 patients were recovered.

Conclusions

Emergency hysterectomy is effective treatment for severe postpartum hemorrhage with inefficient conservative theatments. Placenta factors is the main cause of emergency hysterectomy. We should take effective measures in prevention and treatment of postpartum hemorrhage in order to reduce the occurrence rate of hysterectomy.

Key words: Postpartum hemorrhage, Hysterectomy, Pathogeny, Ending

Haihong Liu, Yinli Cao, Yang Mi, Jin Dong. Clinical analysis of 46 cases on emergency hysterectomy for postpartum hemorrhage.[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2015, 04(02): 114-118.

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https://zhckjjdzzz.cma-cmc.com.cn/EN/Y2015/V04/I02/114

Figures/Tables 2

References 12

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项目		例数	百分率(%)
产次		?	?
?	初产妇	32	7.6
?	经产妇	14	8.8
妊娠年龄		?	?
?	<35岁	36	7.1
?	≥35岁	10	13.3
分娩方式		?	?
?	阴道分娩	4	2.3
?	剖宫分娩	42	10.2
多胎妊娠		?	?
?	无	37	7.4
?	有	9	11.1
受孕方式		?	?
?	自然受孕	36	7.3
?	IVF-ET术后	10	11.1
瘢痕子宫		?	?
?	否	33	6.5
?	是	13	18.1

项目		例数	百分率(%)
产次		?	?
?	初产妇	32	7.6
?	经产妇	14	8.8
妊娠年龄		?	?
?	<35岁	36	7.1
?	≥35岁	10	13.3
分娩方式		?	?
?	阴道分娩	4	2.3
?	剖宫分娩	42	10.2
多胎妊娠		?	?
?	无	37	7.4
?	有	9	11.1
受孕方式		?	?
?	自然受孕	36	7.3
?	IVF-ET术后	10	11.1
瘢痕子宫		?	?
?	否	33	6.5
?	是	13	18.1

产后出血原因		例数	并发症				出血量ml(±s)	处理方式
产后出血原因		例数	DIC＋心力衰竭＋肾衰	心力衰竭＋肺水肿	心力衰竭＋肝损	急性肺栓塞＋DIC＋急性肾衰	出血量ml(±s)	处理方式
胎盘因素		?	?	?	?	?	?	?
?	胎盘植入	6	－	－	－	－	2 683±505	次全切
?	前置胎盘	2	－	1	－	－	2 900±400	次全切
?	凶险型前置胎盘并胎盘植入	11	8	1	1	－	2 855±897	全宫切
?	胎盘残留	1	－	－	－	－	2 500±000	次全切
子宫收缩乏力		?	?	?	?	?	?	?
?	巨大儿	4	－	－	－	－	2 600±616	次全切
?	羊水过多	2	－	－	－	－	2 950±450	次全切
?	多胎妊娠	5	－	－	1	－	2 720±412	次全切
?	疤痕子宫	1	－	－	－	－	2 600±000	次全切
?	合并子宫肌瘤	2	－	－	－	－	2 250±250	次全切
?	继发宫缩乏力	3	－	－	－	－	2 833±287	次全切
胎盘因素和子宫收缩乏力		5	－	1	－	－	3 020±652	次全切
羊水栓塞		2	1	－	－	1	3 000±500	全宫切
晚期产后出血和感染		2	－	－	－	－	2 800±200	次全切

产后出血原因		例数	并发症				出血量ml(±s)	处理方式
产后出血原因		例数	DIC＋心力衰竭＋肾衰	心力衰竭＋肺水肿	心力衰竭＋肝损	急性肺栓塞＋DIC＋急性肾衰	出血量ml(±s)	处理方式
胎盘因素		?	?	?	?	?	?	?
?	胎盘植入	6	－	－	－	－	2 683±505	次全切
?	前置胎盘	2	－	1	－	－	2 900±400	次全切
?	凶险型前置胎盘并胎盘植入	11	8	1	1	－	2 855±897	全宫切
?	胎盘残留	1	－	－	－	－	2 500±000	次全切
子宫收缩乏力		?	?	?	?	?	?	?
?	巨大儿	4	－	－	－	－	2 600±616	次全切
?	羊水过多	2	－	－	－	－	2 950±450	次全切
?	多胎妊娠	5	－	－	1	－	2 720±412	次全切
?	疤痕子宫	1	－	－	－	－	2 600±000	次全切
?	合并子宫肌瘤	2	－	－	－	－	2 250±250	次全切
?	继发宫缩乏力	3	－	－	－	－	2 833±287	次全切
胎盘因素和子宫收缩乏力		5	－	1	－	－	3 020±652	次全切
羊水栓塞		2	1	－	－	1	3 000±500	全宫切
晚期产后出血和感染		2	－	－	－	－	2 800±200	次全切

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