Hamm Rebecca Feldman, Wang Eileen Y, Bastek Jamie A, Srinivas Sindhu K
Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Am J Perinatol. 2017 Apr;34(5):503-507. doi: 10.1055/s-0036-1593535. Epub 2016 Oct 12.
Obstetrical hemorrhage is a leading cause of morbidity and mortality, yet is inconsistently defined. In 2014, the American Congress of Obstetricians and Gynecologists (ACOG) reVITALize program redefined postpartum hemorrhage (PPH) as greater than 1,000 mL blood loss regardless of the mode of delivery (MOD). We sought to assess the reVITALize definition's validity by understanding whether the definition of PPH should, as proposed by ACOG, be one value regardless of MOD. This is a retrospective study of all women who delivered at the hospital of the University of Pennsylvania from October 15, 2013 through December 15, 2013. A total of 592 of the 626 (95%) women were included. The average reported estimated blood loss (EBL) for vaginal delivery (VD) was significantly lower than for cesarean delivery (CD) ([350 ±170 mL) and [880 ± 360 mL]; < 0.001). The average hemoglobin (Hb) drop was only slightly lower for VD compared with CD ([1.4 ± 1.0 g/dL {11.5% drop}] and [1.9 ± 1.2 g/dL {16.2% drop}], respectively, < 0.001). The association between EBL and observed Hb drop differed in accuracy by MOD. Likely based on historic perceptions, obstetric providers estimate blood loss for VD as less than half that of CD. However, using objective measures, blood loss is more similar than perceived between VD and CD, supporting the ACOG reVITALize single definition of PPH regardless of MOD.
产科出血是发病和死亡的主要原因，但定义并不一致。2014年，美国妇产科医师学会（ACOG）的“重新定义产后出血（PPH）以挽救生命（reVITALize）”项目将产后出血重新定义为无论分娩方式如何，失血超过1000毫升。我们试图通过了解PPH的定义是否应如ACOG所提议的那样，无论分娩方式如何都采用一个统一标准，来评估“重新定义产后出血以挽救生命（reVITALize）”定义的有效性。这是一项对2013年10月15日至2013年12月15日在宾夕法尼亚大学医院分娩的所有女性进行的回顾性研究。626名女性中有592名（95%）被纳入研究。经报告的阴道分娩（VD）平均估计失血量（EBL）显著低于剖宫产（CD）（分别为[350±170毫升]和[880±360毫升]；P<0.001）。与剖宫产相比，阴道分娩的平均血红蛋白（Hb）下降幅度仅略低（分别为[1.4±1.0克/分升{下降11.5%}]和[1.9±1.2克/分升{下降16.2%}]，P<0.001）。EBL与观察到的Hb下降之间的关联在不同分娩方式下的准确性有所不同。可能基于历史认知，产科医护人员估计阴道分娩的失血量不到剖宫产的一半。然而，使用客观测量方法，阴道分娩和剖宫产之间的失血量比人们感知的更为相似，这支持了ACOG“重新定义产后出血以挽救生命（reVITALize）”关于无论分娩方式如何都采用单一PPH定义的观点。
