Peripartum Hysterectomies over a Fifteen-year Period

Abstract Objective To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure. Methods A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019. Results The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, andwefound no differencebetween total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age. Conclusion Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.

摘要 目的：明确巴西南部阿雷格里港临床大学医院（Hospital de Clínicas de Porto Alegre，巴西南部分大学医院）过去15年间开展的围产期子宫切除术（peripartum hysterectomies）的适应证与临床转归，并分析接受该手术的女性患者的临床特征。方法：本研究为横断面研究，纳入2005年至2019年间的47例围产期子宫切除术病例。结果：本院开展的围产期子宫切除术主要适应证为胎盘植入（placenta accreta）或疑似胎盘植入，占总病例的44.7%；非胎盘植入相关性产后出血，占27.7%；以及感染，占25.5%。全子宫切除术占总病例的63.8%，且本研究发现全子宫切除术与次全子宫切除术的临床转归无显著差异。绝大多数手术于分娩后24小时内完成，且该类手术的实施与胎盘植入、前置胎盘（placenta previa）及产妇高龄相关。结论：66.0%的患者需转入重症监护室（Intensive Care Unit, ICU）。无需转入重症监护室的患者年龄显著更高，且合并胎盘植入、前置胎盘或有既往剖宫产分娩（Cesarean delivery）史的比例更高。