A Clinical Study on Cesarean Hysterectomy / 대한산부인과학회잡지

ABSTRACT

This study analyzed the outcome of 26 cases of cesarean hysterectomy performed at Wonju Christian Hospital, College of medicine, Yonsei university during 15 years from January, 1982 to May, 1996. There were 27,602 deliveries during this period. Cesarean hysterectomy was performed in 11 of 10,373 cesarean section(0.11 %) and in 15 of 17,229 vaginal deliveries(0.09 %). The age of patients varied from 20 to 48. Indications for emergency cesarean hysterectomy were uterine atony (46.2 %), uterine rupture(26.9 %), and placenta accreta(19.2 %). The relative risk of emergency hysterectomy was 1.22(95 % confidence interval 0.56 to 2.65) for cesarean deliveries, 1.91(95 % confidence interval 0.73 to 4.98) for prior cesarean deliveries and 20.56(95 % confidence interval 10.85 to 38.95) for placenta previa. The patients who had cesarean hysterectomy received from 750 ml to 11,500 ml of blood transfusion with a mean of 3,500 ml. No significant differences in length of operating time, amount of blood loss and postoperative complications were found between total abdominal hysterectomy and subtotal abdominal hysterectomy. In about 1/2 of total patients (46.2 %), there were no operative complications. Maternal death was found in 1 case. Hemorrhage still remains main cause of maternal mortality, the decision of hysterectomy must be conjunction with maternal life saving and free from various dangerous sequalae. So in this study, clinical evaluation for cesarean hysterectomy and an attempt to identify risk factor that might pridict those patients likely to require emergency hysterectomy was made.