阴道分娩后产后出血：危险因素及孕产妇结局
Postpartum hemorrhage following vaginal delivery: risk factors and maternal outcomes.
作者信息
Miller C M, Cohn S, Akdagli S, Carvalho B, Blumenfeld Y J, Butwick A J
机构信息
Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
出版信息
J Perinatol. 2017 Mar;37(3):243-248. doi: 10.1038/jp.2016.225. Epub 2016 Dec 15.
OBJECTIVE
Limited understanding of risk factors exists for postpartum hemorrhage (PPH) post-vaginal delivery. The aim of this study was to identify risk factors for PPH post-vaginal delivery within a contemporary obstetric cohort.
STUDY DESIGN
Retrospective case-control study. PPH was classified by an estimated blood loss ⩾500 ml. Risk factors for PPH were identified using univariable and multivariable logistic regression. We secondarily investigated maternal outcomes and medical and surgical interventions for PPH management.
RESULTS
The study cohort comprised 159 cases and 318 controls. Compared with a second-stage duration <2 h, a second stage⩾3 h was associated with PPH (adjusted odds ratio=2.3; 95% CI=1.2 to 4.6). No other clinical or obstetric variables were identified as independent risk factors for PPH. Among cases, 4% received red blood cells and 1% required intensive care admission.
CONCLUSION
Although PPH-related morbidity may be uncommon after vaginal delivery, PPH should be anticipated for women after a second stage ⩾3 h.
目的
对阴道分娩后产后出血（PPH）的危险因素了解有限。本研究的目的是在当代产科队列中确定阴道分娩后PPH的危险因素。
研究设计
回顾性病例对照研究。PPH根据估计失血量≥500 ml进行分类。使用单变量和多变量逻辑回归确定PPH的危险因素。我们还次要研究了产妇结局以及PPH管理的医疗和手术干预措施。
结果
研究队列包括159例病例和318例对照。与第二产程持续时间<2小时相比，第二产程≥3小时与PPH相关（调整后的优势比=2.3；95%置信区间=1.2至4.6）。未发现其他临床或产科变量是PPH的独立危险因素。在病例中，4%接受了红细胞输注，1%需要入住重症监护病房。
结论
虽然阴道分娩后与PPH相关的发病率可能不常见，但对于第二产程≥3小时的女性应预计会发生PPH。
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