Vendittelli Françoise, Barasinski Chloé, Pereira Bruno, Lémery Didier
Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France.
Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont Université, Clermont-Ferrand, France.
BMC Pregnancy Childbirth. 2016 Aug 24;16(1):242. doi: 10.1186/s12884-016-1008-7.
Most estimates of postpartum hemorrhage (PPH) are calculated from studies that use administrative or medical birth databases, and only a few from prospective observational studies. Our principal objective was to estimate the incidence of PPH according to their severity (mild or severe) in vaginal deliveries (>500 mL, ≥1000 mL) and cesareans (>1000 mL and ≥1500 mL). The secondary objectives were to describe the incidence of PPH according to maternity unit characteristics, causes, and types of PPH management.
This prospective observational study took place in French maternity wards. Women who gave birth at a term ≥ 22 weeks were eligible for the study. 182 maternity units participated in a study with prospective data collection from 1 February, 2011, to 31 July, 2011. The main outcome measure was PPH incidence.
PPH incidence after vaginal delivery was 3.36 % [95 % CI: 3.25-3.47 %] and after cesareans 2.83 % [95 % CI: 2.63-3.04 %]. The incidence of severe PPH after vaginal delivery was 1.11 % [95 % CI: 1.05-1.18 %] and after cesareans 1.00 % [95 % CI: 0.88-1.13 %]. This incidence rate varied according to maternity unit characteristics. The principal cause of PPH for both modes of delivery was uterine atony (57.7 % for vaginal births and 66.3 % for cesareans). Vascular embolization was more frequent among women with cesareans (10.0 vs. 2.9 %), who also required transfusions more often (44.4 vs 12.7 %).
The incidence of PPH was lower than the rate expected from the literature. Effective treatment of uterine atony and optimizing the identification of blood loss remain important priorities.
大多数产后出血（PPH）的评估是基于使用行政或医疗分娩数据库的研究得出的，只有少数来自前瞻性观察研究。我们的主要目标是根据阴道分娩（>500 mL，≥1000 mL）和剖宫产（>1000 mL和≥1500 mL）的严重程度（轻度或重度）来估计PPH的发生率。次要目标是根据产科单位特征、PPH的原因和管理类型来描述PPH的发生率。
这项前瞻性观察研究在法国产科病房进行。妊娠≥22周的分娩妇女符合研究条件。182个产科单位参与了一项研究，从2011年2月1日至2011年7月31日进行前瞻性数据收集。主要结局指标是PPH发生率。
阴道分娩后PPH发生率为3.36%[95%置信区间：3.25 - 3.47%]，剖宫产术后为2.83%[95%置信区间：2.63 - 3.04%]。阴道分娩后严重PPH发生率为1.11%[95%置信区间：1.05 - 1.18%]，剖宫产术后为1.00%[95%置信区间：0.88 - 1.13%]。该发生率因产科单位特征而异。两种分娩方式中PPH的主要原因都是子宫收缩乏力（阴道分娩为57.7%，剖宫产为66.3%）。血管栓塞在剖宫产妇女中更常见（10.0%对2.9%），剖宫产妇女输血也更频繁（44.4%对12.7%）。
PPH的发生率低于文献预期。有效治疗子宫收缩乏力和优化失血识别仍然是重要的优先事项。
