Abstract：
OBJECTIVE: To analyze the incidence, indications, risk factors and pregnancy outcomes of postpartum hemorrhage resulting in peripartum hysterectomy (PH).
METHODS: We retrospectively reviewed patients with postpartum hemorrhage requiring surgical procedures at ≥ 28 weeks of gestation from January 1, 2013 to December 31, 2022 at a tertiary hospital in Shanghai, China. The patients were divided into a PH group and a non-PH group. Maternal clinical characteristics, the management of postpartum hemorrhage, pregnancy outcomes were compared between groups. Logistic regression was used to analyze the correlations between risk factors and PH.
RESULTS: The incidence of hysterectomy was 0.2/1000 deliveries (31/150194). The variables significantly associated with PH were placenta previa with placenta increta/percreta (OR36.26), uterine rupture (OR266.16) and an estimated blood loss ≥ 3513 mL (OR431.11). The proportion of cases involving hemorrhagic shock, disseminated intravascular coagulation, bladder injury, neonatal severe asphyxia, neonatal death and hypoxic-ischemic encephalopathy were significantly higher in the PH group (P < 0.05).
CONCLUSIONS: The most common indications of PH were placental pathology. Efforts should be made to reduce the rate of cesarean deliveries and uterine curettage to lower the probability of abnormal placental invasion and appropriate medical indications for trial of labor after cesarean should be strictly followed to avoid the risk of uterine rupture.
METHODS: We retrospectively reviewed patients with postpartum hemorrhage requiring surgical procedures at ≥ 28 weeks of gestation from January 1, 2013 to December 31, 2022 at a tertiary hospital in Shanghai, China. The patients were divided into a PH group and a non-PH group. Maternal clinical characteristics, the management of postpartum hemorrhage, pregnancy outcomes were compared between groups. Logistic regression was used to analyze the correlations between risk factors and PH.
RESULTS: The incidence of hysterectomy was 0.2/1000 deliveries (31/150194). The variables significantly associated with PH were placenta previa with placenta increta/percreta (OR36.26), uterine rupture (OR266.16) and an estimated blood loss ≥ 3513 mL (OR431.11). The proportion of cases involving hemorrhagic shock, disseminated intravascular coagulation, bladder injury, neonatal severe asphyxia, neonatal death and hypoxic-ischemic encephalopathy were significantly higher in the PH group (P < 0.05).
CONCLUSIONS: The most common indications of PH were placental pathology. Efforts should be made to reduce the rate of cesarean deliveries and uterine curettage to lower the probability of abnormal placental invasion and appropriate medical indications for trial of labor after cesarean should be strictly followed to avoid the risk of uterine rupture.
摘要：
目的：分析发病率，适应症,产后出血导致围产期子宫切除术（PH）的危险因素和妊娠结局。
方法：我们回顾性分析了2013年1月1日至2022年12月31日在上海某三级医院妊娠≥28周需要手术治疗的产后出血患者，中国。将患者分为PH组和非PH组。产妇临床特征,产后出血的管理，比较两组妊娠结局.采用Logistic回归分析危险因素与PH的相关性。
结果：子宫切除术的发生率为0.2/1000（31/150194）。与PH显著相关的变量是前置胎盘伴胎盘植入/胎盘植入(OR36.26),子宫破裂（OR266.16）和估计失血量≥3513mL（OR431.11）。涉及出血性休克的病例比例,弥散性血管内凝血,膀胱损伤,新生儿重度窒息,PH组新生儿死亡和缺氧缺血性脑病发生率明显高于对照组(P<0.05)。
结论：PH最常见的指征是胎盘病理。应努力降低剖宫产和清宫率，以降低胎盘异常侵犯的概率，并应严格遵循适当的医学指征进行剖宫产后试产，以避免子宫破裂的风险。
方法：我们回顾性分析了2013年1月1日至2022年12月31日在上海某三级医院妊娠≥28周需要手术治疗的产后出血患者，中国。将患者分为PH组和非PH组。产妇临床特征,产后出血的管理，比较两组妊娠结局.采用Logistic回归分析危险因素与PH的相关性。
结果：子宫切除术的发生率为0.2/1000（31/150194）。与PH显著相关的变量是前置胎盘伴胎盘植入/胎盘植入(OR36.26),子宫破裂（OR266.16）和估计失血量≥3513mL（OR431.11）。涉及出血性休克的病例比例,弥散性血管内凝血,膀胱损伤,新生儿重度窒息,PH组新生儿死亡和缺氧缺血性脑病发生率明显高于对照组(P<0.05)。
结论：PH最常见的指征是胎盘病理。应努力降低剖宫产和清宫率，以降低胎盘异常侵犯的概率，并应严格遵循适当的医学指征进行剖宫产后试产，以避免子宫破裂的风险。
