Các chỉ định cắt tử cung trong và sau đẻ và một số yếu tố liên quan tại Bệnh viện Phụ sản Hà Nội

Hysterectomy during and after childbirth remains a critical, life-saving procedure in modern obstetrics, primarily employed to manage severe postpartum hemorrhage when conservative interventions are ineffective. Despite global efforts to minimize maternal morbidity and mortality through advanced obstetric techniques and pharmacological agents, the rising incidence of complications such as placenta accreta and uterine atony, often associated with increasing rates of cesarean section, underscores the continued relevance of this major surgery. Understanding the specific indications and contributing factors for peripartum hysterectomy is paramount for improving patient outcomes. This study therefore aims to describe the indications for hysterectomy during and after childbirth and explore related factors at the Hanoi Obstetrics and Gynecology Hospital.

Obstetricians, gynecologists, general practitioners involved in maternal care, medical residents, and healthcare policymakers interested in obstetric emergencies and maternal health outcomes.

This descriptive cross-sectional study investigated 276 cases of hysterectomy performed during and after childbirth at Hanoi Obstetrics and Gynecology Hospital from 2019 to 2023, aiming to characterize its indications and associated factors. Over the five-year period, the overall rate of hysterectomy was 0.16%, demonstrating a slight decreasing trend. The primary cause for peripartum hysterectomy was overwhelmingly postpartum hemorrhage, accounting for 98.1% of cases. The most frequent specific indications identified were placenta accreta (68.1%), uterine atony (13.8%), and uterine fibroids (10.1%). Elective hysterectomy was mainly attributed to placenta accreta and uterine fibroids, whereas emergency procedures were predominantly performed for uterine atony, placenta previa, and uterine rupture. Prior to hysterectomy, various conservative measures were employed, including hemostatic uterotonics (31.2%), uterine control (15.9%), and surgical techniques such as uterine artery ligation (12.7%). The study also revealed statistically significant associations between hysterectomy and factors like increased maternal age and previous cesarean section, particularly for conditions such as placenta accreta, uterine atony, and uterine fibroids. The majority of hysterectomies (91.3%) occurred following cesarean section rather than normal delivery. These findings underscore the critical importance of vigilant antenatal care, early detection of high-risk conditions, and the judicious application of both conservative strategies and timely hysterectomy to improve maternal outcomes in severe obstetric complications.