From the Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; and the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Obstet Gynecol. 2011 Mar;117(3):691-703. doi: 10.1097/AOG.0b013e31820ce2db.
To determine, from the literature, the risk of venous thromboembolism during the postpartum period.
We searched PubMed and Cochrane Library databases for all articles (in all languages) published in peer-reviewed journals from database inception through May 2010 for evidence related to incidence of venous thromboembolism in postpartum women.
We included studies reporting relative risk, incidence rate, or cumulative incidence of venous thromboembolism in postpartum women.
TABULATION, INTEGRATION, AND RESULTS: We included 15 articles reporting findings from 13 studies. Two studies directly comparing venous thromboembolism during the first 6 weeks postpartum to nonpregnant, nonpostpartum women reported relative effect measures of 21.5 (rate ratio; 95% confidence interval [CI] unable to be calculated) and 84 (odds ratio; 95% CI 31.7-222.6), respectively. A third study reported relative effect measures for deep venous thrombosis (15.2, 95% CI 13.2-17.6; standardized incidence ratio) and pulmonary embolism (9.2, 95% CI 6.5-12.7) separately. Three studies reported incidence rates of venous thromboembolism during the postpartum period (range 25-99 per 10,000 woman-years). We compared these incidence rates to baseline rates among nonpregnant, nonpostpartum women reported in the literature to generate rate ratios; these rate ratios ranged from 2.5 to 21.5. Nine studies reported cumulative incidence proportions of postpartum venous thromboembolism, ranging from 0.14 to 3.24 per 1,000 deliveries at 6 weeks postpartum. Incidence of venous thromboembolism was highest immediately after delivery (standardized incidence ratio for deep venous thrombosis 115.1 [95% CI 96.4-137.0], and for pulmonary embolism 80.7 [95% CI 53.9-117.9]); between 4 and 6 weeks postpartum, risk declined but was still approximately five-times to seven-times that of nonpregnant, nonpostpartum women.
During the first 6 weeks postpartum, women's risk of venous thromboembolism increased 21.5-fold to 84-fold from baseline in nonpregnant, nonpostpartum women in studies that included an internal reference group. Although incidence of venous thromboembolism declined quickly after delivery, when this risk returns to baseline is not clear from current data.
从文献中确定产后妇女静脉血栓栓塞的风险。
我们检索了 PubMed 和 Cochrane Library 数据库，以获取所有在同行评审期刊上发表的文章（所有语言），这些文章的发表时间从数据库建立到 2010 年 5 月，以获取与产后妇女静脉血栓栓塞发生率相关的证据。
我们纳入了报告产后妇女静脉血栓栓塞发生率、发病率或累积发病率的相对风险、发病率率或累积发病率的研究。
表格、综合和结果：我们纳入了 15 篇报告了 13 项研究结果的文章。两项直接比较产后 6 周内静脉血栓栓塞与非妊娠、非产后妇女的研究报告了相对效应测量值分别为 21.5（率比；95%置信区间[CI]无法计算）和 84（比值比；95%CI 31.7-222.6）。第三项研究分别报告了深静脉血栓形成（15.2，95%CI 13.2-17.6；标准化发病率比）和肺栓塞（9.2，95%CI 6.5-12.7）的相对效应测量值。三项研究报告了产后期间静脉血栓栓塞的发病率（范围为每 10000 名妇女年 25-99 例）。我们将这些发病率与文献中报告的非妊娠、非产后妇女的基线发病率进行比较，以生成发病率率；这些发病率率范围为 2.5 至 21.5。九项研究报告了产后静脉血栓栓塞的累积发生率，范围为产后 6 周时每 1000 次分娩 0.14 至 3.24 例。静脉血栓栓塞的发生率在分娩后立即最高（深静脉血栓形成的标准化发病率比为 115.1[95%CI 96.4-137.0]，肺栓塞为 80.7[95%CI 53.9-117.9]）；在产后 4 至 6 周时，风险虽有所下降，但仍约为非妊娠、非产后妇女的五至七倍。
在包括内部参考组的研究中，与非妊娠、非产后妇女的基线相比，产后妇女在产后 6 周内静脉血栓栓塞的风险增加了 21.5 至 84 倍。尽管产后静脉血栓栓塞的发生率迅速下降，但目前的数据尚不清楚这种风险何时恢复到基线。
