Sathe Nila A, Likis Frances E, Young Jessica L, Morgans Alicia, Carlson-Bremer Daphne, Andrews Jeff
Assistant Director, Vanderbilt Evidence-Based Practice Center; Assistant in Health Policy, Department of Health Policy, Vanderbilt University Medical Center.
Adjunct Assistant Professor, Vanderbilt University School of Nursing.
Obstet Gynecol Surv. 2016 Feb;71(2):99-113. doi: 10.1097/OGX.0000000000000273.
Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide.
The aim of this study was to systematically review literature on procedures (eg, uterine artery embolization) and uterine-sparing surgeries for PPH.
We searched MEDLINE and other databases from 1990 to November 2014. Two reviewers independently evaluated studies against predetermined criteria, extracted data, and assessed study quality and strength of the evidence (confidence in the effect).
Twenty-eight small studies addressed 1 or more procedures (19 studies of embolization, 5 of uterine tamponade) or surgeries (5 studies of arterial ligation, 5 of uterine compression sutures). Studies primarily evaluated bleeding control and adverse effects. Rates of hemostasis were typically greater than 60% in studies reporting such data after failure of conservative management. Postprocedure infertility occurred in 0% to 43% of women in a small number of studies that reported these data. Uterine tamponade successfully controlled bleeding in more than 50% of women, with few harms reported. Success rates for ligation and sutures ranged from 36% to 96%; harms included surgical injury, infection, and fertility-associated effects.
A limited body of evidence addresses these interventions for PPH. Median rates of hemostasis ranged from 36% to 98%; however, these data come from few studies with less than 2100 total participants. Harms were not well characterized. Some studies with longer-term follow-up reported infertility in women undergoing embolization. Few adverse events with tamponade, ligation, or sutures were reported. Given the insufficient evidence, clinicians must continue to make individual care decisions based on each woman's clinical situation and available management options.
产后出血（PPH）是全球孕产妇死亡和发病的主要原因之一。
本研究的目的是系统回顾关于产后出血的手术操作（如子宫动脉栓塞）和保留子宫手术的文献。
我们检索了1990年至2014年11月的MEDLINE及其他数据库。两名评审员根据预先设定的标准独立评估研究，提取数据，并评估研究质量和证据强度（对效果的信心）。
28项小型研究涉及1种或多种手术操作（19项栓塞研究，5项子宫压迫止血研究）或手术（5项动脉结扎研究，5项子宫压迫缝合研究）。研究主要评估出血控制和不良反应。在报告保守治疗失败后此类数据的研究中，止血率通常大于60%。在少数报告这些数据的研究中，术后不孕发生率为0%至43%。子宫压迫止血成功控制了超过50%女性的出血，报告的不良影响较少。结扎和缝合的成功率在36%至96%之间；不良影响包括手术损伤、感染和与生育相关的影响。
关于产后出血的这些干预措施的证据有限。止血率中位数在36%至98%之间；然而，这些数据来自参与总人数不足2100人的少数研究。不良影响未得到充分描述。一些长期随访研究报告了接受栓塞治疗的女性出现不孕情况。关于压迫止血、结扎或缝合的不良事件报告较少。鉴于证据不足，临床医生必须继续根据每位女性的临床情况和可用的管理选项做出个体化的护理决策。
