Straface Gianluca, Bassi Emma, De Santis Marco, Scambia Giovanni, Zanardo Vincenzo
a Division of Perinatal Medicine , Policlinico Abano Terme , Abano Terme , Italy and.
b Department of Obstetrics and Gynaecology , Catholic University of Sacred Heart , Rome , Italy.
J Matern Fetal Neonatal Med. 2015;28(18):2172-5. doi: 10.3109/14767058.2014.980232. Epub 2014 Nov 14.
In the active management strategy of third stage of labor, the optimal timing for clamping the umbilical cord after birth has been a subject of controversy. We want to evaluate if "two-step" delivery is a risk factor for postpartum hemorrhage (PPH), defined as need of transfusion, comparing to operative delivery, elective caesarean delivery and emergency caesarean delivery.
This is a retrospective cohort study conducted in division of Perinatal Medicine, Policlinico Abano Terme. We evaluated the need of transfusion in all cases of PPH verified in all single deliveries between January 2011 and December 2012. The main outcome measure was blood loss and red blood cell transfusion.
We found 17 cases of PPH (0.88%). The distribution of PPH in relation to mode of delivery was 0.71%, 2.46% and 1.98% respectively for two-step vaginal delivery (RR = 0.81 (0.56-1.22)), emergency cesarean section (RR = 2.88 (1.27-7.77)) and operative vaginal delivery (RR = 2.88 (0.59-5.66)). In labor induction there is a stronger relative risk association between PPH and as emergency cesarean delivery (p < 0.05) as operative vaginal delivery (p < 0.05).
"Two-step" delivery approach did not increase the risk of PPH with respect to operative delivery, elective caesarean section and emergency caesarean section.
在第三产程的积极管理策略中，出生后脐带夹紧的最佳时机一直存在争议。我们想要评估与手术分娩、择期剖宫产和急诊剖宫产相比，“两步”分娩法是否是产后出血（定义为需要输血）的危险因素。
这是一项在阿巴诺泰尔梅综合医院围产医学科进行的回顾性队列研究。我们评估了2011年1月至2012年12月期间所有单胎分娩中确诊的产后出血病例的输血需求。主要观察指标是失血量和红细胞输血情况。
我们发现17例产后出血病例（0.88%）。产后出血与分娩方式的分布情况分别为：“两步”阴道分娩为0.71%，急诊剖宫产为2.46%，手术阴道分娩为1.98%（相对危险度=0.81（0.56 - 1.22）），急诊剖宫产为2.88（1.27 - 7.77），手术阴道分娩为2.88（0.59 - 5.66）。在引产过程中，产后出血与急诊剖宫产（p < 0.05）和手术阴道分娩（p < 0.05）之间存在更强的相对危险度关联。
与手术分娩、择期剖宫产和急诊剖宫产相比，“两步”分娩法并未增加产后出血的风险。
