Seligman K, Ramachandran B, Hegde P, Riley E T, El-Sayed Y Y, Nelson L M, Butwick A J
Department of Anesthesiology and Critical Care Medicine, University of New Mexico, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305, USA.
Int J Obstet Anesth. 2017 May;31:27-36. doi: 10.1016/j.ijoa.2017.03.009. Epub 2017 Mar 22.
Compared to vaginal delivery, women undergoing cesarean delivery are at increased risk of postpartum hemorrhage. Management approaches may differ between those undergoing prelabor cesarean delivery compared to intrapartum cesarean delivery. We examined surgical interventions, blood component use, and maternal outcomes among those experiencing severe postpartum hemorrhage within the two distinct cesarean delivery cohorts.
We performed secondary analyses of data from two cohorts who underwent prelabor cesarean delivery or intrapartum cesarean delivery at a tertiary obstetric center in the United States between 2002 and 2012. Severe postpartum hemorrhage was classified as an estimated blood loss ≥1500mL or receipt of a red blood cell transfusion up to 48h post-cesarean delivery. We examined blood component use, medical and surgical interventions and maternal outcomes.
The prelabor cohort comprised 269 women and the intrapartum cohort comprised 278 women. In the prelabor cohort, one third of women received red blood cells intraoperatively or postoperatively, respectively. In the intrapartum cohort, 18% women received red blood cells intraoperatively vs. 44% postoperatively (P<0.001). In the prelabor and intrapartum cohorts, methylergonovine was the most common second-line uterotonic (33% and 43%, respectively). Women undergoing prelabor cesarean delivery had the highest rates of morbidity, with 18% requiring hysterectomy and 16% requiring intensive care admission.
Our findings provide a snapshot of contemporary transfusion and surgical practices for severe postpartum hemorrhage management during cesarean delivery. To determine optimal transfusion and management practices in this setting, large pragmatic studies are needed.
与阴道分娩相比，接受剖宫产的女性产后出血风险增加。与产时剖宫产相比，临产前剖宫产的管理方法可能有所不同。我们研究了两个不同剖宫产队列中发生严重产后出血的患者的手术干预措施、血液成分使用情况及产妇结局。
我们对2002年至2012年在美国一家三级产科中心接受临产前剖宫产或产时剖宫产的两个队列的数据进行了二次分析。严重产后出血定义为估计失血量≥1500mL或剖宫产术后48小时内接受红细胞输血。我们研究了血液成分使用情况、医疗和手术干预措施以及产妇结局。
临产前队列包括269名女性，产时队列包括278名女性。在临产前队列中，分别有三分之一的女性在术中或术后接受了红细胞输血。在产时队列中，18%的女性在术中接受了红细胞输血，而术后接受输血的比例为44%（P<0.001）。在临产前和产时队列中，甲基麦角新碱是最常用的二线宫缩剂（分别为33%和43%）。接受临产前剖宫产的女性发病率最高，18%的患者需要行子宫切除术，16%的患者需要入住重症监护病房。
我们的研究结果提供了剖宫产期间严重产后出血管理的当代输血和手术实践情况。为了确定这种情况下的最佳输血和管理方法，需要进行大型实用性研究。
