Relationship between Initial Anesthetic methods and Perioperative Courses in Emergency Cesarean Hysterectomy / 대한산부인과학회지

OBJECTIVE: The Purpose of this study was to compare the perioperative variables in patients administered inhalation or regional anesthesia for the initial cesarean section following emergency hysterectomy under general anesthesia. METHODS: Emergency cesarean hysterectomies performed between January 1993 and December 2004 was analyzed retrospectively. There were 65 emergency cesarean hysterectomies during the period. General anesthesia for both delivery and following hysterectomy was employed 24 cases (General group) and regional anesthesia for the initial cesarean section following general anesthesia for emergency hysterectomy was employed 41 cases (Regional group). RESULTS: Most common indication of cesarean hysterectomy was placenta accreta in the both groups. Incidence of uterine atony without pathology was higher in the regional group than in the general group (34.1% vs. 4.2%). There was no difference in the intraoperative managements, estimated blood loss, and transfusions between the two groups. Total perioperative complications were found in 20 out of 65 cases (28.2%), and the incidence of disseminated intravascular coagulopathy (DIC) was higher in the regional group than in the general group (24.4% vs. 4.2%). CONCLUSION: The anesthetic method did not affect the intraoperative managements although the incidence of uterine atony without pathology was higher, and perioperative DIC was more in the regional group than in the general group.

Incidence and risk factors of emergency cesarean hysterectomy.

To identify risk factors associated with emergency cesarean hysterectomy at Siriraj Hospital, medical records of 93 patients who underwent emergency cesarean hysterectomy from January 1986 through December 1995 were retrospectively compared with those of 372 selected controls who underwent cesarean section at the time close to the first group (case : control = 1:4). The incidence of emergency cesarean hysterectomy during the period was 4.07 / 1,000 cesarean sections. Multivariable analysis revealed that age > 35 years (OR=9.7,95% CI : 3.7-24.9), placenta preview (OR = 4.8, 95% CI : 2.2-10.6), age 31-34 years (OR=4.3,95% CI : 1.7-11.3) and parity >3 (OR=3.4,95% CI : 1.6-7.1) were independent factors significantly associated with emergency cesarean hysterectomy (P<0.01). Emergency cesarean hysterectomy remains a necessary procedure for life saving during abdominal delivery. Identification of patients at risk, knowledge of this operation and skill at its performance can be very helpful in reducing maternal morbidity and mortality.