제왕 절개 자궁적출술의 임상적 고찰 = Clinical Study on Cesarean Hysterectomy

다국어 초록 (Multilingual Abstract)

Objective : This article was to review 10 years experience of cesarean hysterectomy at our hospital. To review risk factors, management & outcome of emergency peripartum hysterectomy performed in last 10 years at our hospital. Material & Methods : The outcome of 33 cases of cesarean hysterectomy performed at St. Benedict hospital during 10 years from Jan. 1990 to Dec. 1999 was discussed & evaluated. Results : During this time, there was 16014 deliveries, of which 5640 were cesarean section and 25 were cesarean hysterectomies, an incidence of 0.44%, and of which 10374 were vaginal deliveries 8 were. Cesarian hysterectomies are incidence of 0.08%. The age of patients varies from 18 to 42. The higher the age and the parity of patients, the higher incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was placental abnormal presentation [placenta accreta (30.3%), placenta previa (27.2%)], uterine atony (33.3%), uterine myoma with pregnancy (6.0%) and Uterine ruture (3.0%). The complication were febrile morbidity, disseminated intravascular coagulopathy and urinary tract injury. There was one maternal death. Conclusion : Postoperative complication still remain the causes of maternal morbidity. There careful prenatal care momentary judgement of right operation time, fresh whole blood transfusion and reduction of operation time must be conjunction with maternal life saving. Cesarean delivery, prior cesarean delivery placenta accreta and uterine atony were identified as risk factors for emergency peripartum hysterectomy and abnormal presentation was the primary cause of cesarean hysterectomy. Still, cesarean hysterectomy remains a potentially life saving procedure with which every obstetrician must be familiar.