Department of Obstetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden.
Obstet Gynecol. 2012 Apr;119(4):801-9. doi: 10.1097/AOG.0b013e31824acb3b.
To identify factors related to retained placenta in the context of contemporary obstetric practice.
This was a case-control study comparing 408 cases of retained placenta and an equivalent number of control individuals. Epidemiological and delivery-related variables were registered in computerized prenatal and in-hospital medical records. Univariable and multivariable logistic regressions were used for estimation of risk ratios and statistical significance.
Independent risk factors for retained placenta were: previous retained placenta (odds ratio [OR] 12.61, 95% confidence interval [CI] 3.61-44.08); preterm delivery (OR 3.28, 95% CI 1.60-6.70); oxytocin use for 195-415 minutes (OR 2.00, 95% CI 1.20-3.34); oxytocin use more than 415 minutes (OR 6.55, 95% CI 3.42-12.54, number needed to harm 2.3); preeclampsia (OR 2.85, 95% CI 1.20-6.78); two or more previous miscarriages (OR 2.62, 95% CI 1.31-5.20); and one or more previous abortion (OR 1.58, 95% CI 1.09-2.28). Parity of two or more had a seemingly protective effect (OR 0.40, 95% CI 0.24-0.70), as did smoking at the start of pregnancy (OR 0.28, 95% CI 0.09-0.88). Retained placenta was significantly associated with an increased risk of postpartum hemorrhage. The OR related to blood loss exceeding 500 mL, 1,000 mL, and 2,000 mL and the need for blood transfusion was 33.07 (95% CI 20.57-53.16), 43.44 (95% CI 26.57-71.02), 111.24 (95% CI 27.26-454.00), and 37.48 (95% CI 13.63-103.03), respectively. Diabetes was numerically overrepresented in the case group, but the power of the study to detect a significant difference in risk outcome was insufficient.
Identifying risk factors for retained placenta is important in the assessment of women after delivery. The increased risk associated with duration of oxytocin use is of interest, considering its widespread use.
II.
在当代产科实践背景下，确定与胎盘滞留相关的因素。
这是一项病例对照研究，比较了 408 例胎盘滞留病例和 408 例对照组。在计算机化产前和住院病历中登记了流行病学和分娩相关变量。采用单变量和多变量逻辑回归来估计风险比和统计学意义。
胎盘滞留的独立危险因素为：既往胎盘滞留（比值比 [OR] 12.61，95%置信区间 [CI] 3.61-44.08）；早产（OR 3.28，95% CI 1.60-6.70）；催产素使用 195-415 分钟（OR 2.00，95% CI 1.20-3.34）；催产素使用超过 415 分钟（OR 6.55，95% CI 3.42-12.54，危害人数需要 2.3）；子痫前期（OR 2.85，95% CI 1.20-6.78）；两次或更多次自然流产（OR 2.62，95% CI 1.31-5.20）；以及一次或多次人工流产（OR 1.58，95% CI 1.09-2.28）。两次或更多次的产次似乎有保护作用（OR 0.40，95% CI 0.24-0.70），妊娠开始时吸烟也是如此（OR 0.28，95% CI 0.09-0.88）。胎盘滞留与产后出血风险增加显著相关。与出血量超过 500ml、1000ml 和 2000ml 以及需要输血相关的 OR 分别为 33.07（95% CI 20.57-53.16）、43.44（95% CI 26.57-71.02）、111.24（95% CI 27.26-454.00）和 37.48（95% CI 13.63-103.03）。病例组中糖尿病的数量略多，但本研究检测风险结果差异的效力不足。
确定胎盘滞留的危险因素对于产后妇女的评估很重要。考虑到催产素的广泛使用，与催产素使用时间相关的风险增加值得关注。
II 级。
