Álvarez-Silvares Esther, García-Lavandeira Sandra, Rubio-Cid Paula
Ginecol Obstet Mex. 2015 Jul;83(7):437-46.
To describe the incidence and risk factors for evolution of postpartum haemorrhage towards severe.
Epidemiologic, observational, analytical, case-control study was done from total data of deliveries in Complexo Hospitalario de Ourénse between January 1st 2004 and June 30th 2014. Mann-Whitney U test was used to determine the differences between cases and controls. The statistical analyses were made with the informatic programs Spss 15.0 y Epidat 3.0. We considered statistical significance for p < 0.05.
The initial size of the sample was 17,116 deliveries from which we selected 150 patients with the diagnosis of postpartum haemorrhage. The incidence for HPSe form all deliveries was 3.3% reaching 36% of the total of postpartum haemorrhages. 79.63% of HPSe showed symptoms withing the first 24h postpartum, but we found that 20.37% debuted as secondary postpartum haemorrhages. BMI ≥ 35, hypertensive gestational manifestations, labor's second phase ≥ 120 minutes and weight at birth > 4000 g presented statistical significance as risk factor for evolution to severe postpartum haemhorrage. The relative risk for evolution towards HPSe was 2.81 for instrumental delivery and 3.55 for cesarean section. The most prevalent etiology was uterine atony.
The incidence of HPSe in our hospital is low, as well as secondary maternal mortality. The major risk factor for the appearance of the clinical symptoms is cesarean section, followed, in less proportion by instrumental delivery. It is possible for the HPSe to make its appearance delayed after delivery, usually secondary to infrequent and non well-known clinical presentations.
描述产后出血发展为严重产后出血的发生率及危险因素。
基于奥伦塞综合医院2004年1月1日至2014年6月30日期间分娩的全部数据进行了一项流行病学、观察性、分析性病例对照研究。采用曼-惠特尼U检验来确定病例组与对照组之间的差异。使用Spss 15.0和Epidat 3.0信息程序进行统计分析。我们认为p < 0.05具有统计学意义。
样本初始量为17116例分娩，从中选取了150例诊断为产后出血的患者。严重产后出血在所有分娩中的发生率为3.3%，占产后出血总数的36%。79.63%的严重产后出血在产后24小时内出现症状，但我们发现20.37%表现为继发性产后出血。BMI≥35、妊娠期高血压表现、第二产程≥120分钟以及出生体重>4000g作为发展为严重产后出血的危险因素具有统计学意义。器械助产发展为严重产后出血的相对风险为2.81，剖宫产为3.55。最常见的病因是子宫收缩乏力。
我院严重产后出血的发生率较低，孕产妇继发性死亡率也较低。出现临床症状的主要危险因素是剖宫产，其次是器械助产，但比例较低。严重产后出血可能在分娩后延迟出现，通常继发于不常见且不为人熟知的临床表现。
