Hu Jun, Yu Zhu-Ping, Wang Peng, Shi Chun-Yan, Yang Hui-Xia
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Department of Blood Transfusion, Peking University First Hospital, Beijing 100034, China.
Chin Med J (Engl). 2017 Mar 5;130(5):581-585. doi: 10.4103/0366-6999.200545.
The reports on massive transfusions (MTs) in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage (PPH) and the frequency trends over the past 10 years.
We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units (approximately 1000 ml) of red blood cells within 24 h of giving birth were included. The Pearson's Chi-square and Fisher's exact tests were used to compare the frequency distributions among the categorical variables of the clinical features.
One-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group (2006-2010) and the second 5-year group (2011-2015) (2.5‰ vs. 2.7‰, χ2 = 154.85, P = 0.25). Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities (especially placenta accreta) in the second 5-year group compared with the first 5-year group (34% vs. 23%, χ2 = 188.26, P = 0.03). Twenty-four (23%) women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% (17/24). No maternal death was observed.
There was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.
近期关于产科大量输血（MT）的报道呈上升趋势。我们旨在明确因严重产后出血（PPH）导致的MT的临床特征、危险因素、主要原因、结局以及过去10年的频率趋势。
我们回顾性分析了2006年1月至2015年2月在北京大学第一医院产科妊娠≥28周的3552例PPH患者的数据。纳入在分娩后24小时内接受≥5单位（约1000毫升）红细胞MT的患者的临床记录。采用Pearson卡方检验和Fisher精确检验比较临床特征分类变量之间的频率分布。
在这10年期间，共识别出106例接受MT的女性。前5年组（2006 - 2010年）和后5年组（2011 - 2015年）的MT百分比稳定（2.5‰对2.7‰，χ2 = 154.85，P = 0.25）。虽然子宫收缩乏力仍是MT的主要原因，但与前5年组相比，后5年组胎盘异常（尤其是胎盘植入）呈上升趋势（34%对23%，χ2 = 188.26，P = 0.03）。24例（23%）女性接受了子宫切除术，在所有PPH原因中，胎盘植入的子宫切除率最高，为70%（17/24）。未观察到孕产妇死亡。
PPH病例中MT发生率稳定，但胎盘异常呈上升趋势。胎盘植入导致子宫切除的风险最高。为高危患者，尤其是胎盘植入患者提供适当的输血备用是合理的。
