Department of Obstetrics and Gynecology, Villalba General Hospital, Madrid, Spain.
Engineering School of La Almunia, Universidad de Zaragoza, Zaragoza, Spain.
Int J Gynaecol Obstet. 2018 Feb;140(2):198-204. doi: 10.1002/ijgo.12361. Epub 2017 Nov 9.
To compare maternal morbidity before and after implementation of a postpartum hemorrhage (PPH) protocol that included misoprostol.
A retrospective analysis was performed using data from 34 631 deliveries recorded at a Spanish hospital between January 1, 2007, and December 31, 2014. The PPH protocol was implemented in 2009 and included use of misoprostol and the Bakri balloon.
The pre-implementation and post-implementation groups comprised 9394 and 25 237 women, respectively. Women in the pre-implementation group tended to have lower hemoglobin levels than did those in the post-implementation group: 811 (8.6%) versus 1349 (5.3%) for levels less than 90 g/L, and 272 (2.9%) versus 497 (2.0%) for levels less than 80 g/L (both P<0.001). Implementation of the PPH protocol was also associated with a decrease in the frequency of postpartum hysterectomies owing to uterine atony (0.11 cases per 1000 deliveries vs 0.53 cases per 1000 deliveries for the pre-implementation group; P=0.063). Pregnancy length, maternal age, neonatal weight at delivery, multiple pregnancy, previous cesarean delivery, parity, operative vaginal delivery, induced labor, cesarean delivery, and not using the PPH protocol were found to predict postpartum anemia in the multivariate analysis (all P<0.001).
Implementation of the PPH protocol decreased rates of postpartum anemia and postpartum hysterectomy owing to uterine atony.
比较实施包含米索前列醇的产后出血（PPH）方案前后的产妇发病率。
使用 2007 年 1 月 1 日至 2014 年 12 月 31 日期间在一家西班牙医院记录的 34631 例分娩数据进行回顾性分析。PPH 方案于 2009 年实施，包括使用米索前列醇和 Bakri 球囊。
实施前组和实施后组分别包括 9394 名和 25237 名妇女。实施前组的女性血红蛋白水平较实施后组低：90g/L 以下者分别为 811 例（8.6%）和 1349 例（5.3%），80g/L 以下者分别为 272 例（2.9%）和 497 例（2.0%）（均 P<0.001）。实施 PPH 方案还与因子宫收缩乏力导致的产后子宫切除术的频率降低有关（实施前组为每 1000 例分娩 0.11 例，实施后组为每 1000 例分娩 0.53 例；P=0.063）。多变量分析发现，妊娠长度、产妇年龄、分娩时新生儿体重、多胎妊娠、既往剖宫产、产次、经阴道助产、引产、剖宫产和未使用 PPH 方案均预测产后贫血（均 P<0.001）。
实施 PPH 方案降低了因子宫收缩乏力导致的产后贫血和产后子宫切除术的发生率。
