Clinical charateristcs and high risk factors of intractable postpartum hemorrhage requiring hysterectomy:analysis of 152 patients / 中华围产医学杂志

ABSTRACT

Objective To explore the clinical characteristics and etiology of intractable postpartum hemorrhage requiring hysterectomy. Methods We retrospectively collected 152 patients with intractable postpartum hemorrhage between January 2005 and March 2016 in Department of Obstetrics and Gynecology of Peking University First Hospital. Analysis was conducted to identify the general status, etiology, high risk factors, complications and outcome of patients with or without hysterectomy (hysterectomy group and conservative group). T-test, Rank sum test, and Logistic regression analysis were applied in the statistical analysis. Results (1) Totally 152 patients were identified, accounting for 0.3% of total deliveries during the study period (152/48 694). Among them, 111 cases (73.0%) received routine prenatal care in our hospital; and 41 cases (27.0%) were transferred from other hospitals for high-risk pregnancy. The median blood loss within 24 h after delivery was 1 807(1 027-10 000) ml and 6 (2-42) U of red blood cells was transfused. Totally, uterus was removed in 29 cases (19.1%), with a hysterectomy rate of 0.060% (29/48 694) among all deliveries. (2) The proportion of women with previous cesarean sections [62.1%(18/29) vs 9.8%(12/123), χ2=40.541], the total amount of blood loss within 24 h postpartum [5 145(2 061-10 000) vs 1 586 (1 027-7 350) ml, Z= － 7.671] and of transfused red blood cells [24(6-42) vs 6(2-40) U, Z= － 7.485] were all significantly higher in the hysterectomy group than those of the conservative group. (3) The main causes for intractable postpartum hemorrhage were uterine atony (66/152, 43.4%), placental factors (58/152, 38.2%), soft birth canal injury (21/152, 13.8%) and coagulation dysfunction (7/152, 4.6%). The proportions of placenta factors and coagulation dysfunction in hysterectomy group were higher than those of the conservative group [69.0%(20/29) vs 30.9%(38/123), OR(95% CI) 4.971(2.071-11.912); 20.7%(6/29) vs 0.8%(1/123), OR (95% CI) 31.826(3.654-276.132)], while the proportion of uterine atony was lower [3.4%(1/29) and 52.8%(65/123), OR(95%CI)0.032(0.001-0.241)] (all P<0.01). No statistical difference was shown in the proportion of soft birth canal injury between the two groups. (4) Among the 152 cases, 17.8%(27/152) were admitted into the intensive care unit (ICU) and 15.8%(24/152) experienced severe complications. More postpartum women developed severe complications or being transferred to the ICU in the hysterectomy group than in the conservative group [65.5%(19/29) vs 4.1% (5/123), χ2=72.423; 72.4%(21/29) vs 4.9%(6/123), χ2=73.273; all P<0.001]. Conclusions For women with intractable postpartum hemorrhage cases requiring hysterectomy, previous cesarean section complicating with placenta accreta, is the major reason, while those complicated with coagulation dysfunction carries the highest risk. Meanwhile, those caused by uterine rupture should not be ignored. Although uterine atony remains the leading cause, uterus may be preserved through conservative surgery in most cases in hospitals with adequate medical resources and techniques.