A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Pace 9, 20122 Milan, Italy.
Thromb Res. 2012 Apr;129(4):e1-7. doi: 10.1016/j.thromres.2011.09.010. Epub 2011 Oct 20.
Postpartum hemorrhage is responsible for 25% of maternal pregnancy-related deaths and it is the first cause of maternal morbidity and mortality worldwide.
To define the prevalence of postpartum hemorrhage and associated risk factors after vaginal birth and to develop a risk model that improves postpartum hemorrhage prediction.
All women who underwent a vaginal delivery at the Obstetric Unit of a large University hospital in Milan (Italy) between July 2007 and September 2009 were enrolled. Postpartum hemorrhage was defined as ≥ 500 mL blood loss. A nomogram tailored to predict postpartum hemorrhage was developed, summarizing the impact of each covariate on the probability of postpartum hemorrhage.
6011 women were studied (24% had blood loss ≥ 500 mL and 4.8% ≥ 1000 mL). Nulliparity, episiotomy, retained placenta and high neonatal body weight were confirmed as risk factors for postpartum hemorrhage. The odds ratio of postpartum hemorrhage was 0.86 (95%CI 0.78-0.90) for each 1 gr/dL increase in ante-partum hemoglobin. An extensive internal validation of the developed nomogram demonstrated a good stability of the risk model.
Low ante-partum hemoglobin is a new potentially modifiable risk factor for postpartum hemorrhage. A nomogram to predict the probability of postpartum hemorrhage is now available for external validation.
产后出血导致了 25%的与妊娠相关的孕产妇死亡，是全世界孕产妇发病率和死亡率的首要原因。
明确阴道分娩后产后出血的发生率和相关危险因素，并建立风险模型以提高产后出血的预测能力。
本研究纳入了 2007 年 7 月至 2009 年 9 月期间在意大利米兰一家大型大学附属医院产科分娩的所有产妇。产后出血定义为出血量≥500ml。我们制定了一个专门用于预测产后出血的列线图，总结了每个协变量对产后出血概率的影响。
共纳入 6011 名产妇（24%产妇出血量≥500ml，4.8%产妇出血量≥1000ml）。初产妇、会阴切开术、胎盘残留和新生儿体重大是产后出血的危险因素。产前血红蛋白每增加 1g/dl，产后出血的比值比（OR）为 0.86（95%CI 0.78-0.90）。对开发的列线图进行了广泛的内部验证，证明了风险模型的稳定性良好。
产前低血红蛋白是产后出血的一个新的潜在可改变的危险因素。现在有一个预测产后出血概率的列线图可供外部验证。
