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Background. Emergency postpartum hysterectomy (PH) is generally performed in the situation of life threatening haemorrhage. Incidence according to the literature is between 1/300 and 1/5000 labours. The leading cause in developedworld is placenta accreta. Besides standard methods (aplication of drugs, revision of uterus, bimanual compression of uterus etc.), conservativesurgical methods and embolization of vessels are increasingly used. We wanted to establish the incidence of PH in the Ljubljana Maternity Hospital, use of conservative surgical methods and matching of histological and operative diagnosis. We wanted to check the possibilities for embolizationof vessels. Methods. Retrospective analysis of PH in the years 1992-2002 in the Ljubljana Maternity Hospital was done and the incidence of PHwas calculated. We analysed patients regarding indications for PH, sort of operation and matching of histological and operative diagnose. We checked the possibilities for embolization of uterine vessels. Results. In the mentioned period 20 labours ended with PH (incidence 1/3124 labours). 17 patients were multiparas, PH was done after caesarean section in 9 cases. The mostcommon indication was rupture of the uterus (6 cases), followed by inflammation of the uterus (5 cases) and atony (4 cases). Among conservative methods, application of 15-metil PGF2alpha and oxytocin were most commonly used, the next two were manual exploration of uterine cavity and uterine packing. None of conservative surgical methods were used. Histological and operative diagnosis matched in 16 cases. There were no maternal and neonatal deaths. Conclusions. The incidence of PH in the Ljubljana Maternity Hospital is low. The leading two causes are uterine rupture and inflammation of uterus. None ofconservative surgical methods were used. There are good possibilities for embolization of uterine vessels. Izhodišča. Urgentno poporodno historektomijo (PH) naredimo pri življensko nevarni poporodni krvavitvi. Incidenca se, po podatkih iz literature, giblje med 1/330 in 1/5000 porodov. Vodilni vzrok v razvitem svetu je placenta akreta. Poleg standardnih ukrepov (dajanjezdravil, iztipanje maternice, bimanualna kompresija maternice ipd.) se vse bolj uveljavljajo konzervativne kirurške metode zdravljenja in embolizacija žil. Želeli smo ugotovitiincidencoPH v Porodnišnici Ljubljana, uporabo konzervativnih metod ustavljanja krvavitve ter ujemanje operativne in histološke diagnoze. Zanimaleso nas možnosti in pogoji za zdravljenje poporodne krvavitve z embolizacijo. Metode. Narejena je bila retrospektivna analiza PH v letih 1992-2002 v Porodnišnici Ljublana in izračunana incidenca PH. Analizirali smo podatke o bolnicah, indikacija za PH, vrsti operacije ter ujemanju histološke in operativne diagnoze. Proučili smo možnost za embolizacijo materničnih žil. Rezultati. V omenjenem obdobju se je v Porodnišnici Ljubljana 20 porodov končalo s PH (incidenca 1/3124 porodov). 17 bolnic je bilo multipar, v 9 primerih je bila narejena PH po carskem rezu. Najpogostejša indikacija je bilaruptura maternice (6 primerov), sledita vnetje maternice (5 primerov) in atonija (4 primeri). Med konzervativnimi metodami je bilo najpogostejše dajanje 15-metil PGF2alfa in oksitocina, sledila sta iztipanje in tamponada maternice. V nobenem primeru ni bila uporaba konzervativna kirurška metoda ustavljanja krvavitve. Histološka in operativna diagnoza sta se ujemali v 16 primerih. Ni bilo maternalne in neonatalne smrti. Incidenca PH v Porodnišnici Ljubljana je nizka. Vodilna vzroka sta ruptura maternice in vnetje maternice. Konzervativne kirurške metode ustavljanja krvavitve niso bile uporabljene. Obstajajo dobre možnosti za embolizacijo materničnih žil. |
