Clinical Analysis on Emergency Postpartum Hysterectomy / 대한주산의학회잡지

ABSTRACT

OBJECTIVE: To analyze incidence, indications, risk factors, complications, and neonatal outcomes of emergency postpartum hysterectomies performed at EulJi University Medical Center. METHODS: A retrospective study of all cases of postpartum hysterectomies between May. 1996 and Dec. 2000. was carried out. RESULTS: 37 cases of postpartum hysterectomies during this period were performed, for overall incidnce of 2.3 per 1000 deliveries. Incidence after vaginal delivery and cesarean section was 0.03% and 0.52% respectively. The rate of postpartum hysterectomy increased with increasing age and parity. The main indications were placental disorders(54.1%) including placenta previa and adherent placenta, uterine atony(37.8%), uterine myoma(5.4%) and uterine rupture(2.7%) in order. The relative risk of postpartum hysterectomy according to the risk factors was 97.6(95% confidence interval 52.17-184.06) for placental disorders, 16.3(95% confidence interval 4.94-52.31) for cesarean section and 2.4(95% confidence interval 1.21-4.76) for previous cesarean section. The mean amount of transfuion was 17.1 pints. Although no maternal mortality had occurred, 16 patients(43.2%) had complica-ions including respiratory complication(13.5%), hemorrhagic complication(10.8%), infection(8.1%) and urologic injury(8.1%). Regarding fetal outcome, 2 of 38 infants(1 case, twin) were stillborn (5.3%) and 10 infants(26.3%) were suffered from various illness including prematurity, sepsis, meningitis, and brain hemorrhage. CONCLUSION: The data identifies placental disorders are the leading cause of postpartum hysterectomy. Although postpartum hysterectomy is a necessary life-saving operation, maternal morbidity remained high.