Department of Anaesthesia and
Department of Anaesthesia and.
Br J Anaesth. 2014 Oct;113(4):661-8. doi: 10.1093/bja/aeu150. Epub 2014 Jun 6.
Uterine atony (UA) is recognized as a leading cause of postpartum haemorrhage. However, knowledge of risk factors of haemorrhage-related morbidity among patients diagnosed with UA is uncertain. We investigated risk factors for haemorrhage-related morbidity among patients undergoing Caesarean delivery with UA.
We conducted a secondary analysis of data sourced from a 4-yr observational study at 19 US academic centres. Patients with UA were identified based on receiving methylergonovine or carboprost. Our primary outcome (haemorrhage-related morbidity) included a composite of intra- or postpartum transfusion; Caesarean hysterectomy; uterine or hypogastric artery ligation; intensive care admission for: pulmonary oedema, coagulopathy, adult respiratory distress syndrome, postoperative ventilation, or invasive line monitoring.
Among 57,182 patients who underwent Caesarean delivery, 2294 (4%) patients developed UA. Haemorrhage-related morbidity occurred in 450 (19.6%) patients with UA. The risk of haemorrhage-related morbidity was increased among African-Americans [adjusted odds ratio (aOR)=2.36; 95% confidence interval (CI)=1.73-3.23], Hispanics (aOR=1.4; 95% CI=1.04-1.9), women with multiple gestations (aOR=1.59; 95% CI=1.06-2.38), placenta praevia (aOR=4.89; 95% CI=3.04-7.87), patients with ASA class III (aOR=1.4; 95 CI=1.03-1.9), or ASA class IV (aOR=5.88; 95% CI=2.48-13.9), exposure to general anaesthesia (GA) (aOR=2.4; 95% CI=1.59-3.62) and combined general and regional anaesthesia (aOR=4.0; 95% CI=2.62-6.09), and ≥2 prior Caesarean deliveries (aOR=1.62; 95% CI=1.1-2.39).
Among patients with UA undergoing Caesarean delivery, the risk of haemorrhage-related morbidity is increased in African-Americans, Hispanics, patients with multiple gestations, placenta praevia, ASA class III or IV, ≥2 prior Caesarean deliveries and those undergoing GA.
子宫收缩乏力（UA）被认为是产后出血的主要原因。然而，对于诊断为 UA 的患者中与出血相关的发病率的危险因素的了解并不确定。我们调查了在 19 个美国学术中心进行剖宫产术的 UA 患者中与出血相关的发病率的危险因素。
我们对来自美国 19 个学术中心的一项为期 4 年的观察性研究的数据进行了二次分析。根据接受甲麦角新碱或卡前列素治疗，确定 UA 患者。我们的主要结局（与出血相关的发病率）包括以下任何一种的复合结果：术中或产后输血；剖宫产子宫切除术；子宫或下腹动脉结扎术；因肺水肿、凝血功能障碍、成人呼吸窘迫综合征、术后通气、或有创线监测而入住重症监护病房。
在 57182 例行剖宫产术的患者中，有 2294 例（4%）发生 UA。UA 患者中有 450 例（19.6%）发生与出血相关的发病率。非裔美国人（调整后的优势比[aOR]=2.36；95%置信区间[CI]=1.73-3.23）、西班牙裔（aOR=1.4；95% CI=1.04-1.9）、多胎妊娠（aOR=1.59；95% CI=1.06-2.38）、前置胎盘（aOR=4.89；95% CI=3.04-7.87）、ASA 分级 III 类（aOR=1.4；95 CI=1.03-1.9）或 IV 类（aOR=5.88；95% CI=2.48-13.9）、全身麻醉（GA）暴露（aOR=2.4；95% CI=1.59-3.62）和全身麻醉与区域麻醉联合（aOR=4.0；95% CI=2.62-6.09）、以及≥2 次剖宫产术史（aOR=1.62；95% CI=1.1-2.39）的患者，发生与出血相关的发病率的风险增加。
在接受剖宫产术的 UA 患者中，非裔美国人、西班牙裔、多胎妊娠、前置胎盘、ASA 分级 III 或 IV 类、≥2 次剖宫产术史以及接受 GA 的患者发生与出血相关的发病率的风险增加。
