Abstract: Objective To analyze the risk factors so as to provide a theoretical basis for reducing the rate of obstetric hysterectomy. Methods Clinical data of 47 patients undergoing obstetric hysterectomy during July 2016 and June 2021 were retrospectively analyzed. Results In the past 5 years, the rate of hysterectomy in the Obstetric Department of Shandong Provincial Hospital Affiliated to Shandong First Medical University was 1.22‰. Postpartum hemorrhage ranked the first risk factor for hysterectomy(41 cases), followed by pregnancy with gynecological malignant tumors(3 cases), uterine necrosis caused by puerperal infection(2 cases), and placental implantation after induced labor in the second trimester(1 case). The main cause of postpartum hemorrhage was pernicious placenta previa and accreta(90.24%, 37/41), followed by advanced pregnancy with giant uterine fibroids(4.88%, 2/41), uterine inertia(2.44%, 1/41)and pregnancy acute fatty liver with DIC(2.44%, 1/41). Among 37 cases of pernicious placenta previa and accreta, 19(51.35%)underwent subtotal hysterectomy, and 18(48.65%)total hysterectomy. The average amount of blood loss and blood transfusion in the total hysterectomy cases were higher than those in the subtotal hysterectomy cases(P<0.05). Of the 37 patients with pernicious placenta previa and accreta, 54.05%(20/37)received vascular interventional procedures, including abdominal aortic balloon occlusion and iliac vascular occlusion. The average blood loss of the vascular intervention cases was lower than that of the non-vascular intervention cases(P<0.05). Conclusion Postpartum hemorrhage caused by pernicious placenta previa and accreta is the main cause of hysterectomy. For serious and pernicious cases of placenta previa and accreta, appropriate interventional surgery and subtotal hysterectomy can reduce blood loss and improve the prognosis.

Key words: Postpartum hemorrhage, Hysterectomy, Pernicious placenta previa and accreta, Vascular interventional procedures