Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA.
Division of Angiology and Hemostasis, Department of Specialties of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Chest. 2016 Sep;150(3):572-96. doi: 10.1016/j.chest.2016.05.021. Epub 2016 Jun 1.
Cesarean sections (CS) are believed to be associated with greater risks of postpartum VTE. Our objective was to systematically review the evidence on this association and on the absolute risk of VTE following CS.
We searched PubMed, Embase, and conference proceedings from 1980 to November 2015 for reports on the associations of delivery methods with postpartum VTE and on the incidence of VTE following CS. Studies on thrombophilia or recurrent VTE were excluded, and the search was restricted to prospective studies when assessing the incidence of VTE. Pooled relative and absolute risks were estimated with random effects models.
The search retrieved 28 mostly retrospective observational studies comparing risks of VTE following CS and following vaginal deliveries (VD) (> 53,000 VTE events) and 32 prospective studies reporting risks of VTE following CS (218 VTE events). Compared with VD, the relative risk of VTE following CS ranged from 1 to 22, with a meta-analytic OR of 3.7 (95% CI, 3.0-4.6). Adjustment for age and BMI had a marginal influence on the estimated pooled OR. Associations were observed for both elective and emergency CS, with stronger estimates of associations for emergency CS. The pooled incidence was 2.6 VTE per 1,000 CS (95% CI, 1.7-3.5) and was greater in studies with a longer and better follow-up in the postpartum period (4.3 per 1,000 CS).
The risk of VTE was fourfold greater following CS than following VD; seemed independent of other VTE risk factors; and was greater following emergency CS than following elective CS. On average, three in 1,000 women will develop a VTE following CS.
人们认为剖宫产（CS）与产后静脉血栓栓塞症（VTE）的风险增加有关。我们的目的是系统地回顾有关这一关联以及 CS 后 VTE 的绝对风险的证据。
我们检索了 1980 年至 2015 年 11 月期间 PubMed、Embase 和会议论文集，以查找有关分娩方式与产后 VTE 相关的报告，以及 CS 后 VTE 发生率的报告。排除血栓形成倾向或复发性 VTE 的研究，并在评估 VTE 的发生率时，将检索范围限制为前瞻性研究。使用随机效应模型估计汇总的相对和绝对风险。
检索结果共纳入 28 项主要的回顾性观察性研究，比较了 CS 与阴道分娩（VD）后 VTE 的风险（>53000 例 VTE 事件），以及 32 项报告 CS 后 VTE 风险的前瞻性研究（218 例 VTE 事件）。与 VD 相比，CS 后 VTE 的相对风险范围为 1 至 22，荟萃分析的 OR 为 3.7（95%CI，3.0-4.6）。对年龄和 BMI 进行调整对估计的汇总 OR 仅有轻微影响。在择期和紧急 CS 中均观察到相关性，紧急 CS 的相关性更强。汇总发生率为每 1000 例 CS 中有 2.6 例 VTE（95%CI，1.7-3.5），在产后期间随访时间更长和更好的研究中发生率更高（每 1000 例 CS 中有 4.3 例）。
CS 后 VTE 的风险是 VD 的四倍；似乎独立于其他 VTE 危险因素；且紧急 CS 后比择期 CS 后更大。平均而言，每 1000 名妇女中有 3 名会在 CS 后发生 VTE。
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