Department of Obstetrics and Gynecology, Stavanger University Hospital, Norway.
Acta Obstet Gynecol Scand. 2010 Oct;89(10):1248-55. doi: 10.3109/00016349.2010.514324.
To analyze changes in postpartum hemorrhage over a 10-year period from 1998 to 2007, and to explore factors associated with severe hemorrhage.
Retrospective cohort study, prospectively collected information.
Stavanger University Hospital, a secondary referral center, Norway.
An unselected population of 41,365 women giving birth at the hospital.
We analyzed changes over time in mean postpartum hemorrhage, severe postpartum hemorrhage and associated factors. Estimated blood loss >1,000 ml was defined as severe hemorrhage. Data were collected from the hospital's database.
Severe postpartum hemorrhage and obstetric interventions.
We observed an increase in severe hemorrhage during the study period. After cesarean sections, the risk of severe hemorrhage was twice the risk of severe hemorrhage after vaginal deliveries (5.9%; 95% CI 5.3-6.6 vs. 2.8%; 95% CI 2.6-2.9). The most important factors associated with severe hemorrhage following vaginal deliveries were twin deliveries (OR 6.8), retained placenta (OR 3.9) and inductions of labor (OR 2.2). For cesarean sections, twin deliveries had the strongest association with severe hemorrhage (OR 3.7) followed by general anesthesia (OR 3.0). Obstetric interventions became more frequent; elective cesarean sections increased from 2.4 to 4.9%, acute cesarean sections from 5.5 to 8.9%, operative vaginal deliveries from 9.3 to 12.5%, inductions of labor from 14.3 to 15.8% and augmentations of labor from 5.8 to 29.3%.
The incidence of severe postpartum hemorrhage increased, and this may be related to more frequent use of obstetric interventions.
分析 1998 年至 2007 年 10 年间产后出血的变化，并探讨与严重出血相关的因素。
回顾性队列研究，前瞻性收集信息。
挪威斯塔万格大学医院，二级转诊中心。
该医院分娩的 41365 名未选择的妇女。
我们分析了产后出血、严重产后出血和相关因素随时间的变化。估计出血量＞1000ml 定义为严重出血。数据来自医院数据库。
严重产后出血和产科干预措施。
我们观察到研究期间严重出血有所增加。剖宫产术后，严重出血的风险是阴道分娩的两倍（5.9%；95%CI 5.3-6.6 比 2.8%；95%CI 2.6-2.9）。与阴道分娩后严重出血相关的最重要因素是双胞胎分娩（OR 6.8）、胎盘滞留（OR 3.9）和引产（OR 2.2）。对于剖宫产，双胞胎分娩与严重出血的相关性最强（OR 3.7），其次是全身麻醉（OR 3.0）。产科干预措施变得更加频繁；择期剖宫产从 2.4%增加到 4.9%，急症剖宫产从 5.5%增加到 8.9%，阴道助产从 9.3%增加到 12.5%，引产从 14.3%增加到 15.8%，催产从 5.8%增加到 29.3%。
严重产后出血的发生率增加，这可能与产科干预措施的频繁使用有关。
