Kaul Virochana, Bagga Rashmi, Jain Vanita, Gopalan Sarala
Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012, India.
Indian J Med Sci. 2006 Jun;60(6):233-40.
To assess risk factors, mortality and "near-miss" morbidity in early PPH.
Retrospective analysis of 178 women with early PPH (within 24 h of delivery) over 4 consecutive years in a tertiary care hospital in North India.
All case sheets of patients identified by labor record registers as having early PPH were reviewed by the same person to identify the actual impact of condition. The data was analyzed by chi-square analysis.
Early PPH (loss of blood that caused significant alteration in maternal condition or blood loss 500 in vaginal deliveries or> 1000 cc in cesarean section) was recorded in 178; 90 delivered in hospital (Group-A) and 88 referred after delivery (Group-B) from various peripheral centers, i.e., maternity hospitals, nursing homes, district and community health centers. The maternal mortality ratio during this period was 1049/100,000 (139 deaths/13248 live births; direct maternal deaths = 94). Early PPH accounted for 11/94 direct maternal deaths (11.7%). Of these 11 deaths, 3 were in group A and 8 in group B. "Near-miss" morbidity was higher than mortality (Total 19/178; 5/90 in Group-A and 14/88 in Group-B). Delayed referral and lack of active 3rd stage management in Group-B were responsible for most of the adverse events.
Both "near-miss" morbidity and mortality in early PPH reflect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.
评估早期产后出血（PPH）的危险因素、死亡率及“接近死亡”的发病率。
对印度北部一家三级护理医院连续4年的178例早期PPH（分娩后24小时内）妇女进行回顾性分析。
由同一人查阅产程记录登记册中确定为早期PPH患者的所有病历，以确定病情的实际影响。采用卡方分析对数据进行分析。
记录到178例早期PPH（失血导致产妇状况显著改变，或阴道分娩失血500毫升或剖宫产失血>1000毫升）；90例在医院分娩（A组），88例在产后从各个外围中心（即妇产医院、疗养院、地区和社区卫生中心）转诊（B组）。在此期间，孕产妇死亡率为1049/10万（139例死亡/13248例活产；直接孕产妇死亡94例）。早期PPH占94例直接孕产妇死亡中的11例（11.7%）。在这11例死亡中，A组3例，B组8例。“接近死亡”的发病率高于死亡率（共19/178；A组5/90，B组14/88）。B组转诊延迟和缺乏积极的第三产程管理是导致大多数不良事件的原因。
早期PPH的“接近死亡”发病率和死亡率均反映了发展中国家的产科护理水平。需要通过加强外围分娩设施、积极的第三产程管理和早期转诊来降低这些情况的发生。
