University of Pittsburgh School of Medicine, the Departments of Anesthesiology and Pathology, University of Pittsburgh, and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2013 Jul;122(1):120-126. doi: 10.1097/AOG.0b013e3182941c78.
To determine whether the California Maternal Quality Care Collaborative risk groups predicted the risk of peripartum hemorrhage and to determine which women should have peripartum pretransfusion testing performed.
Over a 1-year period, 10,134 women who delivered at a single hospital were included in this retrospective cohort study. The majority of the California Maternal Quality Care Collaborative risk factors were assessed retrospectively. Each mother was assigned to one of the three peripartum hemorrhage risk groups according to the guidelines. The individual peripartum hemorrhage risk factors and the three risk groups correlated with the occurrence of a significant peripartum hemorrhage (a hemorrhage requiring transfusion of 1 unit or more of red blood cells). Other risk factors for peripartum hemorrhage were assessed and a modified high-risk category was created.
The incidence of a significant peripartum hemorrhage within each group was as follows: low (0.8%); medium (2.0%); and high (7.3%). High included an increase that was statistically significant (P<.001). All of the assessed California Maternal Quality Care Collaborative risk criteria were significantly associated with an increased peripartum hemorrhage rate (P≤.02) except macrosomnia and morbid obesity. Other risk factors not included in the California Maternal Quality Care Collaborative criteria (preterm delivery, uterine rupture, hypertension, previous cesarean delivery, and a model of accreta or percreta) also correlated with peripartum hemorrhage. This modified risk group included 85% of those women with significant hemorrhage; however, 45% of women were included and only 2.6% of this modified group hemorrhaged.
The California Maternal Quality Care Collaborative risk stratification showed an increasing risk for transfusion as the risk grade increased. Women in the California Maternal Quality Care Collaborative high-risk group (or as determined by their providers) should have pretransfusion testing performed.
II.
确定加利福尼亚产妇质量护理协作组的风险因素是否预测了围产期出血的风险，并确定哪些妇女应进行围产期输血前检测。
在为期一年的时间里，这项回顾性队列研究纳入了在一家医院分娩的 10134 名妇女。大部分加利福尼亚产妇质量护理协作组的风险因素都是回顾性评估的。根据指南，每位母亲被分配到围产期出血风险组中的一个。个体围产期出血的风险因素和三个风险组与发生显著围产期出血（需要输注 1 个单位或更多红细胞的出血）相关。评估了其他围产期出血的风险因素，并创建了一个改良的高危类别。
每个组中显著围产期出血的发生率如下：低危（0.8%）；中危（2.0%）；高危（7.3%）。高危组的发生率显著增加（P<.001）。除巨儿症和病态肥胖外，所有评估的加利福尼亚产妇质量护理协作组风险标准均与围产期出血发生率增加显著相关（P≤.02）。加利福尼亚产妇质量护理协作组标准中未包括的其他风险因素（早产、子宫破裂、高血压、既往剖宫产术和粘连或植入性胎盘模型）也与围产期出血相关。这个改良的风险组包括 85%有显著出血的妇女；然而，有 45%的妇女被包括在内，只有 2.6%的改良组出血。
加利福尼亚产妇质量护理协作组的风险分层显示，随着风险等级的增加，输血的风险增加。加利福尼亚产妇质量护理协作组高危组（或由其提供者确定）的妇女应进行输血前检测。
II。
