van Stralen Giel, von Schmidt Auf Altenstadt Joost F, Bloemenkamp Kitty W M, van Roosmalen Jos, Hukkelhoven Chantal W P M
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands.
Acta Obstet Gynecol Scand. 2016 Oct;95(10):1104-10. doi: 10.1111/aogs.12950. Epub 2016 Aug 23.
An increase of postpartum hemorrhage (PPH) has been reported in many high-income countries. In addition to this data, this study reports on trends in the incidence of PPH in the Netherlands in 2000-2013, and examines the extent to which temporal changes in risk indicators could explain a possible change in incidence of PPH.
We used data from the Dutch Perinatal Registry, which contains prospectively collected antenatal, peripartum and neonatal data of 95-99% of all women and neonates in the Netherlands. We selected births ≥22 weeks of gestation from January 2000 until December 2013. Changes in the incidence of PPH and its risk indicators were studied over time. Main outcome measure was PPH, defined as blood loss >1000 mL within 24 h following delivery.
The data comprised 2 406 784 women. The incidence of PPH rose significantly from 4.1% in 2000 to 6.4% in 2013 (p < 0.0001). The incidence of previously identified risk indicators for PPH increased over time. Manual removal of placenta was strongly associated with PPH (OR 29.3, CI 28.8-29.8). The incidence of PPH-related blood transfusion decreased remarkably.
In line with international observations, Dutch data suggest a considerable increase in the incidence of PPH which can only partly be explained by the studied risk indicators. The decreasing incidence of obstetric blood transfusion suggests an increased incidence of blood loss of 1000-1500 mL.
许多高收入国家都报告了产后出血（PPH）发生率的上升。除了这些数据外，本研究报告了2000 - 2013年荷兰产后出血的发生率趋势，并研究了风险指标的时间变化在多大程度上可以解释产后出血发生率的可能变化。
我们使用了荷兰围产期登记处的数据，该登记处前瞻性收集了荷兰95 - 99%的所有妇女和新生儿的产前、围产期及新生儿数据。我们选取了2000年1月至2013年12月妊娠≥22周的分娩病例。研究了产后出血发生率及其风险指标随时间的变化。主要结局指标为产后出血，定义为分娩后24小时内失血>1000 mL。
数据包括2406784名妇女。产后出血的发生率从2000年的4.1%显著上升至2013年的6.4%（p < 0.0001）。先前确定的产后出血风险指标的发生率随时间增加。人工剥离胎盘与产后出血密切相关（比值比29.3，可信区间28.8 - 29.8）。产后出血相关输血的发生率显著下降。
与国际观察结果一致，荷兰的数据表明产后出血发生率大幅上升，而所研究的风险指标只能部分解释这一现象。产科输血发生率的下降表明失血量为1000 - 1500 mL的发生率增加。
