Merriam Audrey A, Wright Jason D, Siddiq Zainab, D'Alton Mary E, Friedman Alexander M, Ananth Cande V, Bateman Brian T
a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA.
b Department of Epidemiology , Joseph L. Mailman School of Public Health, Columbia University , New York , NY , USA.
J Matern Fetal Neonatal Med. 2018 Apr;31(8):1025-1034. doi: 10.1080/14767058.2017.1306050. Epub 2017 Apr 3.
The objective of this study was to characterize risk for and temporal trends in postpartum hemorrhage across hospitals with different delivery volumes.
This study used the Nationwide Inpatient Sample (NIS) to characterize risk for postpartum hemorrhage from 1998 to 2011. Hospitals were classified as having either low, moderate or high delivery volume (≤1000, 1001 to 2000, >2000 deliveries per year, respectively). The primary outcomes included postpartum hemorrhage, transfusion, and related severe maternal morbidity. Adjusted models were created to assess factors associated with hemorrhage and transfusion.
Of 55,140,088 deliveries included for analysis 1,512,212 (2.7%) had a diagnosis of postpartum hemorrhage and 361,081 (0.7%) received transfusion. Risk for morbidity and transfusion increased over the study period, while the rate of hemorrhage was stable ranging from 2.5 to 2.9%. After adjustment, hospital volume was not a major risk factor for transfusion or hemorrhage.
While obstetric volume does not appear to be a major risk factor for either transfusion or hemorrhage, given that transfusion and hemorrhage-related maternal morbidity are increasing across hospital volume categories, there is an urgent need to improve obstetrical care for postpartum hemorrhage. Those risk factors are able to discriminate women at increased risk supports routine use of hemorrhage risk assessment.
本研究的目的是描述不同分娩量医院产后出血的风险及时间趋势。
本研究使用全国住院患者样本（NIS）来描述1998年至2011年产后出血的风险。医院被分类为分娩量低、中或高（分别为每年≤1000例、1001至2000例、>2000例分娩）。主要结局包括产后出血、输血及相关的严重孕产妇发病情况。建立调整模型以评估与出血和输血相关的因素。
纳入分析的55140088例分娩中，1512212例（2.7%）诊断为产后出血，361081例（0.7%）接受了输血。在研究期间，发病和输血风险增加，而出血率稳定，在2.5%至2.9%之间。调整后，医院分娩量不是输血或出血的主要风险因素。
虽然产科分娩量似乎不是输血或出血的主要风险因素，但鉴于不同分娩量类别的医院中，与输血和出血相关的孕产妇发病情况都在增加，迫切需要改善产后出血的产科护理。那些能够区分风险增加的女性的风险因素支持常规使用出血风险评估。
