Department of Obstetrics & Gynecology, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark.
Acta Obstet Gynecol Scand. 2013 Apr;92(4):421-5. doi: 10.1111/j.1600-0412.2012.01520.x. Epub 2012 Sep 18.
To estimate the prevalence and validate the diagnosis of retained placenta in nulliparous women and the risk of reoccurrence at subsequent vaginal delivery.
Nested cohort study.
Department of Gynecology and Obstetrics, university-affiliated teaching hospital.
10 334 nulliparous singleton pregnancies who delivered vaginally at the hospital during 2000-2009.
Data from a computerized database information system were used to identify 287 women who had an ICD-10 diagnosis of retained placenta and 572 randomly selected controls matched by the date of first delivery. At chart review the diagnosis was confirmed by: (1) excessive bleeding <30 minutes after delivery without placental separation, (2) placenta not separated 30 minutes after delivery or (3) confirmation of retained placental tissue >2 hours postpartum.
Confirmation of the diagnosis and prevalence of retained placenta. Risk of reoccurrence in a subsequent vaginal delivery.
The prevalence of retained placenta increased from 2.8 to 7.0% after confirmation according to the set criteria. Of the selected women, 48.4% had a subsequent vaginal delivery. Of these women, 25.3% (23/91) with a previous retained placenta and 5.3% (11/206) without previously retained placenta, experienced retained placenta in subsequent delivery. This corresponds to an adjusted odds ratio of 5.5 (95% confidence interval 2.6-12.7) in the multivariate analysis for recurrence of retained placenta in a subsequent vaginal delivery.
The use of the ICD-10 diagnosis of retained placenta underestimated the prevalence. The risk of reoccurrence of retained placenta is significantly increased in a subsequent vaginal delivery.
估计初产妇胎盘滞留的患病率并验证其诊断，并评估其在随后经阴道分娩时再次发生的风险。
巢式队列研究。
大学附属医院妇产科。
2000 年至 2009 年在该医院经阴道分娩的 10334 名初产妇单胎妊娠。
利用计算机数据库信息系统的数据，确定了 287 例 ICD-10 诊断为胎盘滞留的患者，并随机选择了 572 名同期分娩的患者作为对照。通过病历回顾，根据以下三种情况确认诊断：（1）产后 30 分钟内出血量超过 30ml 且胎盘未分离；（2）产后 30 分钟胎盘仍未分离；（3）产后 2 小时以上确认胎盘组织残留。
诊断的确认和胎盘滞留的患病率。随后经阴道分娩时再次发生胎盘滞留的风险。
根据设定的标准，胎盘滞留的患病率从 2.8%增加到确诊后的 7.0%。在选定的妇女中，48.4%有随后的经阴道分娩。在这些妇女中，25.3%（23/91）有既往胎盘滞留，5.3%（11/206）无既往胎盘滞留，在随后的分娩中发生胎盘滞留。在多变量分析中，这对应于随后经阴道分娩时胎盘滞留复发的调整比值比为 5.5（95%置信区间 2.6-12.7）。
ICD-10 诊断胎盘滞留的使用低估了患病率。在随后的经阴道分娩中，胎盘滞留再次发生的风险显著增加。
