제왕절개 자궁적출술에 관한 임상적 연구

Abstract

Objective : Cesarean hysterectomy is associated with high risks of severe blood loss, postoperative complication, and maternal morbidity. This study was undertaken to identify the risk factors of cesarean hysterectomy and to reduce the postoperative complications and maternal morbidity. Methods : The outcomes of 101 cases of cesarean hysterectomy performed at Severance hospital of Yonsei University, from January 1986 to April 2001 were reviewed. Results : There were 31,044 deliveries during this period. Cesarean hysterectomy was done in 54 of 11,924 cesarean sections (0.45%) and in 18 cases of 19,120 vaginal deliveries (0.09%), so more frequently after cesarean section than vaginal delivery. And 29 cases (28.72%) were referred from other hospitals. The mean age and parity were 31.3 years old and 1.1, respectively. Interval between delivery and hysterectomy were 169 minutes in vaginal delivery and 49 minutes in cesarean section. The amount of blood transfusion were 1,908m1 and 1,536ml, respectively. The hospital stay were 10.6 days in vaginal delivery and 10.9 days in cesarean section. The most common indication of cesarean hysterectomy was uterine atony (41.58%) followed by placenta previa with accreta (23. 76%), placenta accreta(16.83%) and placenta previa(11.88%). Comparing among placenta previa with accreta, placenta accreta and placenta previa, the most amount of blood, 1,734m1, was transfused in cases of placenta previa with accreta. In cases of emergency cesarean section, more cesarean hysterectomies (55.93%) occurred than in cases of elective cesarean section (44.06%). Conclusion : The risk factors of cesarean hysterectomy were placenta abnormalities and prior ces￢arean delivery. Hemorrhage still remains as a main cause of maternal mortality, so the decision of hysterectomy must be conjunction with maternal lifesaving and free from various dangerous sequelae. And careful prenatal care is needed in risk groups of postpartum bleeding.