Abstract
Objectives:To investigate the indications of obstetric emergency hysterectomy and analyze the clinical effects of subtotal hysterectomy and total hysterectomy.Methods:We included 247 hospitalized women who had undergone abdominal hysterectomy due to obstetric reasons in Fujian Province Maternity and Child Health Hospital (a provincial class-A hospital) and Ningde People’s Hospital (a primary Class-B hospital) between January 2002 and December 2018. We identified surgical indications and clinical characteristics of the patients. Furthermore, the patients from Fujian Provincial Maternity and Child Health Hospital were subdivided into subtotal hysterectomy group and total hysterectomy group to examine general operation conditions, and postoperative complications.Results:The main surgical indications for emergency obstetric hysterectomy in Fujian Maternity and Child Health Hospital were placental implantation (49.6%) and uterine weakness (31.9%), while uterine weakness (37.5%) was the most important indication in Ningde People’s Hospital. No differences were found in operation time, hospitalization time, intraoperative blood loss, postpartum blood loss, and intraoperative fresh frozen plasma transfusion between the subtotal hysterectomy group and the total hysterectomy group. Postoperative test parameters, including postoperative prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), hemoglobin (HGB), and hematocrit (HCT), were not significantly different between the two groups. No significant difference was noted in postoperative vesicoureteral injury, pelvic hematoma, infection, and disseminated intravascular coagulation (DIC) incidence, but renal failure incidence was different (P=0.040).Conclusion:The treatment effect of subtotal hysterectomies for the cases without placenta accreta and placenta previa was similar in the two hospitals. There is no statistically significant difference in therapeutic effect between total hysterectomy and subtotal hysterectomy.
Highlights
Obstetric emergency hysterectomy, as a method for saving patients with refractory obstetric hemorrhaging, is generally performed after 20 weeks of pregnancy and within 24 hours of fetal birth.[1]
Obstetric emergency hysterectomy can be subdivided into total hysterectomy and subtotal hysterectomy
This study retrospectively analyzes surgical methods, surgical indications, and general conditions leading to obstetric emergency hysterectomy within different hospital categories
Summary
As a method for saving patients with refractory obstetric hemorrhaging, is generally performed after 20 weeks of pregnancy and within 24 hours of fetal birth.[1] treatment techniques have improved, the incidence of emergency hysterectomy (0.22%-0.62%)[2,3,4] has not significantly decreased alongside increasing cesarean section incidence.[5]. The main indications for emergency obstetric hysterectomy are placental abnormalities, uterine weakness, and uterine rupture.[6,7] Obstetric emergency hysterectomy can be subdivided into total hysterectomy and subtotal hysterectomy. The pros and cons of the two techniques have been investigated, whether subtotal hysterectomy should be performed prior to total hysterectomy remains controversial. This study retrospectively analyzes surgical methods, surgical indications, and general conditions leading to obstetric emergency hysterectomy within different hospital categories. There is a particular paucity of data on this subject for the southeast coastal areas of China, especially for primary hospitals where refractory obstetric hemorrhage treatment is relatively limited due to resource scarcity
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