Postpartum hysterectomy

Objectives: To review cases of postpartum hysterectomy regarding indications, risk factors and complications and compare them with cases of emergency cesarean section. Methods: We conducted a retrospective chart review study of 20 cases of postpartum hysterectomy and 20 cases of emergency cesarean section performed at Sinai Samaritan Medical Center, Milwaukee, Wisconsin, between January 1984 and January 1994. Emergency postpartum hysterectomies were compared with emergency cesarean sections regarding obstetric history, placental location, operative time, blood loss, blood transfusion, intra- and postoperative complications and length of hospitalization. Emergency hysterectomies were reviewed according to their indications for the incidence of complications and length of hospitalization. Pathological diagnoses of the hysterectomy specimens were reviewed. Statistical analyses were performed using the two-tailed Student's t-test and Fisher's exact test. Results: Placenta accreta was the most common indication for emergency postpartum hysterectomy. Prior cesarean section and/or placenta previa were risk factors. Emergency hysterectomies were associated with longer operating times (P < 0.0001), greater blood loss (P < 0.0001), more transfusions (P < 0.001), postoperative complications (P < 0.01), secondary surgeries (P < 0.01) and longer hospitalizations (P < 0.0001) than cases of emergency cesarean section. Conclusions: Emergency postpartum hysterectomy is associated with significant blood loss, need for transfusion, postoperative complications and longer hospitalization partly because of its indications. The combination of prior cesarean section and current placenta previa should alert the obstetrician that an emergency postpartum hysterectomy may be needed.     

保守性手术控制剖宫产术严重产后出血的效果

目的:探讨改良子宫捆扎术与宫腔填纱术控制剖宫产术严重产后出血的临床效果,并分析失败原因。方法:将135例剖宫产术严重产后出血患者按数字表法随机分为改良子宫捆扎术组(捆扎组,65例)和宫腔填纱术组(填纱组,70例),比较2组手术操作时间、术中及术后出血量、止血成功率、子宫切除率和并发症发生率。结果:捆扎组的手术时间、术中出血量明显少于填纱组(P0.05);2组术后出血量、止血成功率、子宫切除率比较差异无统计学意义(均P0.05);捆扎组胎盘因素中前置胎盘和胎盘植入出血者的止血成功率低于填纱组(P0.05),子宫过度伸展因素出血者的止血成功率高于填纱组(P0.05);2组产妇术后恶露持续时间、月经复潮时间及经量减少、痛经及宫腔粘连和产褥期感染的发生率比较差异无统计学意义(均P0.05)。结论:改良子宫捆扎术术中出血量少,操作时间短,对子宫过度伸展性因素出血的止血效果更佳;而宫腔填纱术适用于胎盘因素出血者,临床处理应个体化。     

产后出血的研究进展

产后出血（PPH）是导致孕产妇患病及死亡的常见原因之一,目前多数定义为阴道分娩后24 h累计失血量≥500 mL,剖宫产术后累计失血量≥1 000 mL。但PPH的诊断不仅要以失血量为依据,也要重视血流动力学的改变。缩宫素作为预防和治疗PPH的一线药物已成为共识,卡贝缩宫素、卡前列素氨丁三醇和米索前列醇等亦可应用。具有PPH高危因素的孕妇,剖宫产术中除预防使用缩宫素之外,还可考虑静脉使用氨甲环酸以减少出血。尚无证据表明哪一种手术治疗方式更佳,常需根据实际情况进行选择。发生PPH时,凝血功能异常是大量输血和子宫切除的预测指标,当出血难以控制时,早期输注纤维蛋白原是安全和有效的。早期识别,综合处理,建立团队,总结和模拟演练都是PPH处置不可或缺的环节。     

Intrauterine Bakri Balloon and Vaginal Tamponade Combined with Abdominal Compression for the Management of Postpartum Hemorrhage

Objective

This study sought to investigate the effect of Bakri balloon use and vaginal tamponade combined with abdominal compression for the management of postpartum hemorrhage (PPH).

658例产后出血病例分析

目的:探讨不同产后出血量患者的妊娠结局、干预措施及输血情况。方法:回顾性分析我院2010年1月至2014年12月期间产后出血的658例患者的临床资料,并根据出血量1500 ml、1500~2500 ml、≥2500 ml进行分组分析。比较不同产后出血量患者的妊娠结局、干预措施及输血情况。结果:1500 ml组、1500~2500 ml组、≥2500 ml组3组产妇弥散性血管内凝血(DIC)、失血性休克、肺损伤的发生率比较差异有统计学意义(P0.01)。73例因保守措施难以控制而采取了子宫切除术的患者,其出血量中位数达4000 ml。出血量≥2500 ml采取子宫切除的比例显著高于出血量小的组(χ2=123.1,P0.05)。子宫切除组瘢痕子宫、凶险性前置胎盘及羊水栓塞的比例显著高于保守治疗止血组(P0.01)。接受输血治疗者中按治疗单位计算输注红细胞悬液∶新鲜冰冻血浆平均数为1∶1.15。结论:对产后出血量进行临床分级,将有助于指导治疗方案、把握治疗时机。针对产科出血特点,需进一步规范产后出血的输血管理。     

产后出血的干预性治疗

目的：探讨产后出血干预治疗的合理方案。方法：回顾性分析15例行干预性治疗的严重产后出血患者的临床特点及方法。结果：15例患者中子宫切除者9例，行动脉栓塞治疗7例（2例切除子宫后双行栓塞治疗），行病灶挖除术1例。需行干预性治疗的产后出血的原因依次为：弥漫性血管内凝血（DIC），子宫动－静脉瘘及血管畸形，胎盘异常，子宫肌瘤及子宫裂伤。结论：应针对产后出血的不同原因、部位及性质选择合理有效的干预治疗，以抢救患者生命，保留生育功能，尽可能减少创伤。     

米索前列醇治疗顽固性产后出血13例报告

目的探讨米索前列醇对宫缩乏力性产后出血的治疗效果.方法对13例宫缩乏力性产后出血产妇,在采用缩宫素、麦角新碱治疗无效后,给予口服米索前列醇800 μg.结果13例产妇口服米索前列醇后,在3～12 min内子宫收缩加强,出血得到控制,无一例子宫切除.结论应用米索前列醇治疗顽固性产后出血,效果显著,可推广使用.     

阴道分娩后出血的抢救及预防

目的:探讨引起产后出血的原因及防治措施。方法:对41例阴道分娩后2小时内出血量≥400ml的产妇的临床资料进行回顾性分析。结果:阴道分娩后出血主要原因为宫缩乏力35例(73.17%)、软产道裂伤2例(4.88%)、胎盘胎膜残留、子宫破裂、脂肪肝和羊水栓塞各1例(2.44%)。40例治愈。死亡1例。结论:产后出血是受多种因素影响,多发生在产后2h内。规范孕产期保健,提高医务人员业务水平,加强产后2h内监测,早期治疗是预防和抢救产后出血的关键。     

产后出血的治疗

产后出血（postpartum hemorrhage）是我国孕产妇死亡的首要原因,导致产后出血的主要因素有子宫收缩乏力、软产道裂伤、胎盘因素、贫血和凝血功能障碍等。近年来,由于我国生育政策的调整,孕产妇平均年龄逐渐升高,产后出血的发病率和严重程度也呈增长趋势,医疗机构应结合产妇实际情况识别产后出血,注重对产后出血原因的分析和研究,并及时进行预防和采取有效的应对措施,制定个体化治疗策略,保持母体血流动力学稳定,促进子宫收缩,实施适当的外科手术以及恰当的血液制品输注,必要时使用氨甲环酸、重组人活化因子Ⅶ和纤维蛋白原等药物,改善止血,使患者得到及时有效的治疗,降低出血相关死亡率,提高患者生活质量。     

血钙浓度与欣母沛预防产后出血的相关性研究

目的：探讨钙离子与欣母沛在预防产后出血中的协同作用。方法：选择2003—2010年在天津市水阁医院分娩无凝血功能障碍、无胎盘因素、无软产道裂伤,分娩后给予缩宫素20 U肌内注射15～30 min仍有活动性出血,及时给予欣母沛预防产后出血患者59例。按分娩前1周内所测血钙结果分为2组：正常血钙组27例,低血钙组32例。比较2组患者术中出血量、应用欣母沛治疗后24 h累计出血量、产后出血发生率和欣母沛用量。结果：低血钙组产妇与正常血钙组产妇在术中、应用欣母沛治疗后24 h累计出血量、产后出血发生率、欣母沛总量方面比较,差异均有统计学意义（均P＜0.01）。结论：血清钙浓度与欣母沛在预防产后出血中具有协同作用。     

B-Lynch缝合法在剖宫产术中产后出血的应用

目的:探讨B-Lynch缝合法治疗剖宫产术中产后出血的疗效。方法:选择行剖宫产术中出现产后出血者80例为研究对象,其中40例应用B-Lynch缝合法止血(观察组),40例应用传统方法进行止血(对照组),将2组有效率、术中出血情况、手术时间和住院费用等进行对比。结果:与对照组相比,观察组术中、术后出血量少,住院时间短,住院费用低,差异均有统计学意义(P<0.01),且术后恢复良好,无并发症发生。结论:B-Lynch缝合法是治疗剖宫产术中产后出血的有效方法,值得推广。     

未诊断的产后出血160例临床分析

目的：探讨未诊断的产后出血（undiagnosed postpartum hemorrhage,UDPPH）的发生原因、临床特点、影响因素及预防措施。方法：回顾性分析2013年1月—2017年12月于中国人民解放军第161医院行阴道分娩的产妇1 528例的临床资料,将其分为产后出血（postpartum hemorrhage,PPH）组、UDPPH组和对照组（既无PPH也无UDPPH者）,分析UDPPH的临床特点及影响因素,并与PPH组进行比较。结果：阴道分娩中UDPPH和PPH发生率分别为10.5%和6.1%,UDPPH组和PPH组的产前血红蛋白均低于对照组,孕次、总产程时间、第三产程时间、胎盘滞留发生率、会阴损伤发生率均高于对照组,差异有统计学意义（P＜0.05）,UDPPH组的初产妇比例、会阴侧切发生率均高于对照组,差异有统计学意义（P＜0.05）,而PPH组初产妇比例、会阴侧切发生率与对照组比较差异无统计学意义（P＞0.05）,初产妇比例、会阴侧切发生率是UDPPH不同于PPH的影响因素。结论：UDPPH在阴道分娩产妇中很常见,为降低其发生率,需要加强产后观察、正确评估出血量以及针对其影响因素进行预防。     

Selective pelvic arterial embolization in the management of obstetric hemorrhage

OBJECTIVE: Retrospective evaluation of pelvic arterial embolization for the treatment of severe post-partum hemorrhage. METHODS: Data were collected, from our departmental clinical records, on all patients with life-threatening post-partum hemorrhage managed with arterial embolization between January 2001 and December 2003. RESULTS: During the period analyzed, there were 29,119 deliveries in our institution. Of these, 27 patients underwent pelvic arterial embolization to control severe hemorrhaging despite conservative management. Of the 27 patients, 22 (81.5%) had a vaginal delivery and 5 had a caesarean section. The major indication for embolization was uterine atony (15 women). Disseminated intravascular coagulation developed in 20 cases (74.1%). There were eight cases (29.6%) who underwent hysterectomy, seven of them pre-embolization. The most frequent vessel embolized was the uterine artery (13 cases; 38.3%). One patient (3.7%) presented complications related to the procedure. The success rate was 96.3%. CONCLUSION: Pelvic arterial embolization is a good therapeutic choice for severe post-partum hemorrhage refractory to conservative treatment measures.     

分娩过程中使用缩宫素对产后出血的影响

目前,产后出血仍是孕产妇死亡的主要原因之一,研究证实分娩过程中使用缩宫素增加了产后出血的发生风险,尤其是在缩宫素使用时间过长、浓度过高或未积极管理第三产程时。缩宫素受体的脱敏反应是其主要病理生理学机制,临床上表现为后续缩宫素诱导的子宫收缩反应性降低,进而引起宫缩乏力和产后出血。综述使用缩宫素与产后出血的相关性研究进展,帮助临床医生建立合理的缩宫素管理方案,减少宫缩乏力性产后出血的发生。     

新生儿性别和产妇心理对产后出血的影响

目的了解新生儿性别和产妇心理对产后出血的影响.方法采用症状自评量表(SCL-90),自制问卷对300例产妇进行评定;精确测量产后2 h出血量;按新生儿性别分两组进行比较.结果女婴组产妇SCL-90分比男婴组高,尤其经产妇明显,P＜0.01,有显著意义.女婴组产后2 h出血量及产后出血发生率均高于男婴组,经产妇更显著(P＜0.01).结论切盼男婴的产妇心理状态有影响,当对新生儿性别不满意时可引起产后宫缩乏力从而导致产后出血.产科医护人员应对切盼男婴的产妇进行心理疏导.     

产后出血不同时段出血量的危险因素分析

目的:探讨产后出血不同时段出血量的危险因素。方法:整理156例产后出血产妇临床资料,比较胎盘娩出前、胎盘娩出时、产后30分钟、产后30分钟～1小时、产后1～2小时、产后2～4小时、产后4～6小时、产后6～24小时8个时段的出血量,多元线性回归分析其与相关临床资料的相关性。结果:①胎盘娩出时出血量最多(均P<0.05);产后30分钟次之(均P<0.05);余时段出血量渐少,但差异均无统计学意义(均P>0.05)。②入院时体重指数(BMI)、宫高分别与胎盘娩出前、胎盘娩出时出血量呈明显正相关(B=0.341和0.345,均P<0.05);入院时血红蛋白(Hb)及红细胞(RBC)、孕期产前检查次数分别与胎盘娩出时、产后30分钟出血量呈明显负相关(B=-0.354、-0.751和-0.237,均P<0.05);有异常妊娠史胎盘娩出前出血量明显升高(P<0.05);剖宫产或胎盘娩出异常者胎盘娩出时出血量明显升高(均P<0.05);并发羊水过多、宫高≥40cm、双胎或巨大儿之一产后2小时内各时段出血量均明显升高(均P<0.05)。结论:产后30分钟内出血最显著,产后不同时段出血量的危险因素不同。     

Pseudoaneurysm of Uterine Artery: A Rare Cause of Secondary Postpartum Hemorrhage

Objectives

Secondary PPH has received little attention. In more than half of cases the etiology is not made out. Vascular abnormalities like pseudoaneurysm and AV malformation are rare but detectable and easily treatable.

Methods

This is an analysis of five women presenting with severe secondary PPH after the 3rd to 6th week of postpartum. All women were post LSCS with no identifiable cause and referred for further management. They were diagnosed to have pseudoaneurysm by angiography and uterine artery embolisation was done.

Results

Five women were analysed. Four of them had a pseudoaneurysm and were embolised one woman was hemodynamically unstable and hence taken up for hysterectomy.

Conclusion

Pseudoaneurysm is an important vascular abnormality especially following LSCS. Uterine artery embolisation is safe and reliable alternative technique and prevents a hysterectomy.