Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
The Netherlands Perinatal Registry, Utrecht, The Netherlands.
PLoS One. 2013 Dec 18;8(12):e81959. doi: 10.1371/journal.pone.0081959. eCollection 2013.
Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Identifying risk indicators for postpartum haemorrhage is crucial to predict this life threatening condition. Another major contributor to maternal morbidity and mortality is pre-eclampsia. Previous studies show conflicting results in the association between pre-eclampsia and postpartum haemorrhage. The primary objective of this study was to investigate the association between pre-eclampsia and postpartum haemorrhage. Our secondary objective was to identify other risk indicators for postpartum haemorrhage in the Netherlands.
A nationwide cohort was used, containing prospectively collected data of women giving birth after 19 completed weeks of gestation from January 2000 until January 2008 (n = 1,457,576). Data were extracted from the Netherlands Perinatal Registry, covering 96% of all deliveries in the Netherlands. The main outcome measure, postpartum haemorrhage, was defined as blood loss of ≥1000 ml in the 24 hours following delivery. The association between pre-eclampsia and postpartum haemorrhage was investigated with uni- and multivariable logistic regression analyses.
Overall prevalence of postpartum haemorrhage was 4.3% and of pre-eclampsia 2.2%. From the 31 560 women with pre-eclampsia 2 347 (7.4%) developed postpartum haemorrhage, compared to 60 517 (4.2%) from the 1 426 016 women without pre-eclampsia (odds ratio 1.81; 95% CI 1.74 to 1.89). Risk of postpartum haemorrhage in women with pre-eclampsia remained increased after adjusting for confounders (adjusted odds ratio 1.53; 95% CI 1.46 to 1.60).
Women with pre-eclampsia have a 1.53 fold increased risk for postpartum haemorrhage. Clinicians should be aware of this and use this knowledge in the management of pre-eclampsia and the third stage of labour in order to reach the fifth Millenium Developmental Goal of reducing maternal mortality ratios with 75% by 2015.
产后出血是全球产妇发病率和死亡率的主要原因。确定产后出血的风险指标对于预测这种危及生命的情况至关重要。另一个导致产妇发病率和死亡率的主要因素是子痫前期。先前的研究表明，子痫前期与产后出血之间的关联存在矛盾结果。本研究的主要目的是调查子痫前期与产后出血之间的关联。我们的次要目的是确定荷兰产后出血的其他风险指标。
使用全国性队列，包含 2000 年 1 月至 2008 年 1 月期间 19 周妊娠后分娩的女性前瞻性收集的数据（n = 1,457,576）。数据从荷兰围产期登记处提取，涵盖荷兰所有分娩的 96%。主要结局测量指标是产后 24 小时内出血量≥1000ml 的产后出血。使用单变量和多变量逻辑回归分析调查子痫前期与产后出血之间的关联。
产后出血的总体患病率为 4.3%，子痫前期的患病率为 2.2%。在 31,560 名患有子痫前期的妇女中，有 2347 名（7.4%）发生了产后出血，而在 1,426,016 名没有子痫前期的妇女中，有 60,517 名（4.2%）发生了产后出血（比值比 1.81；95%置信区间 1.74 至 1.89）。在调整混杂因素后，患有子痫前期的妇女发生产后出血的风险仍然增加（调整后的比值比 1.53；95%置信区间 1.46 至 1.60）。
患有子痫前期的妇女产后出血的风险增加 1.53 倍。临床医生应该意识到这一点，并在管理子痫前期和第三产程时利用这一知识，以实现到 2015 年将产妇死亡率降低 75%的第五个千年发展目标。
