产程第三阶段延长的产科特征及产后出血风险

Obstetric characteristics for a prolonged third stage of labor and risk for postpartum hemorrhage.

作者信息

Magann Everett F, Doherty Dorota A, Briery Christian M, Niederhauser Amy, Chauhan Suneet P, Morrison John C

机构信息

Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA, USA.

出版信息

Gynecol Obstet Invest. 2008;65(3):201-5. doi: 10.1159/000112227. Epub 2007 Dec 10.

DOI:10.1159/000112227

PMID:18073485

Abstract

AIM

To determine the obstetric characteristics associated with a prolonged third stage of labor and risk factors for a postpartum hemorrhage (PPH) in women undergoing vaginal delivery.

METHOD

Secondary analysis of a prospective randomized investigation comparing placental removal at 20 versus 30 min to prevent PPH.

RESULTS

Between 1 March 2004 and 1 March 2005, 1,607 women were recruited. Eighty-nine percent of the placentas had delivered by 10 min (n = 1,430) and 10.5% (n = 168) had delivered between 10 and 20 min, leaving 8 retained placentas (0.5%) >20 min. Simultaneous factors predictive of longer duration of third stage of labor included maternal age > or =35 years (hazard ratio HR = 0.990, 95% CI 0.981-0.999, p = 0.030) and duration of second stage of labor >2 h (HR = 0.745, 95% CI 0.628-0.883, p = 0.001) relative to second stage of labor <1 h. Significant risk factors for PPH included chorioamnionitis (odds ratio OR = 6.45, 95% CI 2.37-17.64, p < 0.001), nulliparity (OR = 2.38, 95% CI 1.19-4.77, p = 0.014), overdistended uterus (OR = 2.81, 95% CI 1.02-7.76, p = 0.047) and third stage of labor >10 min (OR = 6.45 95%, CI 2.73-22.84, p < 0.001 compared with third stage < or =5 min).

CONCLUSIONS

Prolonged third stage of labor is correlated with an older maternal age and a prolonged second stage of labor. Significant risk factors for PPH include chorioamnionitis, an overdistended uterus and a third stage of labor >10 min.

摘要

目的

确定与阴道分娩妇女第三产程延长相关的产科特征以及产后出血（PPH）的危险因素。

方法

对一项前瞻性随机研究进行二次分析，该研究比较了20分钟与30分钟时胎盘娩出以预防PPH的情况。

结果

在2004年3月1日至2005年3月1日期间，招募了1607名妇女。89%（n = 1430）的胎盘在10分钟内娩出，10.5%（n = 168）在10至20分钟之间娩出，8个胎盘（0.5%）在20分钟后仍未娩出。预测第三产程持续时间较长的同时因素包括产妇年龄≥35岁（风险比HR = 0.990，95%可信区间CI 0.981 - 0.999，p = 0.030）以及第二产程持续时间>2小时（HR = 0.745，95% CI 0.628 - 0.883，p = 0.001），而第二产程<1小时。PPH的显著危险因素包括绒毛膜羊膜炎（比值比OR = 6.45，95% CI 2.37 - 17.64，p < 0.001）、初产（OR = 2.38，95% CI 1.19 - 4.77，p = 0.014）、子宫过度扩张（OR = 2.81，95% CI 1.02 - 7.76，p = 0.047）以及第三产程>10分钟（与第三产程≤5分钟相比，OR = 6.45，95% CI 2.73 - 22.84，p < 0.001）。