Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2019 Jul;238:114-119. doi: 10.1016/j.ejogrb.2019.05.022. Epub 2019 May 19.
We studied the incidence of postpartum hemorrhage and manual removal of the placenta and their recurrence rate in a subsequent pregnancy. We hypothesized that the risk of recurrence was dependent on the gestational age at first birth and whether or not a manual removal of the placenta was necessary. Knowledge on this subject can potentially improve counselling, prevention and management in obstetric care for women at risk for PPH or identify women at low risk for recurrence.
This was a retrospective national cohort study consisting of women with two consecutive singleton deliveries between 1999 and 2009 in the Netherlands. A longitudinal linked national cohort with information on subsequent singleton deliveries in the Netherlands was used. Main outcome measures were: postpartum hemorrhage (defined as ≥1000 mL after vaginal delivery or Caesarean section) and manual removal of the placenta. We calculated incidence and recurrence rates of postpartum hemorrhage and manual removal of the placenta for all women and stratified by gestational age.
After application of in- and exclusion criteria 359 737 women were studied. A total of 5.4% women experienced postpartum hemorrhage in the first pregnancy and 2.7% of women had a manual removal of the placenta. The risk of postpartum hemorrhage in a subsequent pregnancy was significantly higher in women with a history of postpartum hemorrhage compared to women without a previous postpartum hemorrhage (18% vs 3.9%, adjusted odds ratio 4.5; 95% confidence interval 4.3-4.7). The risk of manual removal of the placenta in the second pregnancy was only 1.4% in women without a previous manual removal compared to 17% of women with a previous manual removal of the placenta. Women with a manual removal of the placenta in the first pregnancy between 32 and 37 weeks were most at risk for recurrence (adjusted odds ratio 8.9; 95% confidence interval 7.2-11).
Women with a previous delivery complicated by postpartum hemorrhage or manual removal of the placenta are at increased risk for recurrence. The magnitude of this risk is highest in women with deliveries beyond 32 weeks in the first pregnancy.
我们研究了产后出血和人工胎盘剥离的发生率及其在后续妊娠中的复发率。我们假设，复发的风险取决于初产妇的胎龄以及是否需要人工胎盘剥离。对这一问题的认识有可能改善对有产后出血风险或复发风险低的妇女的产科护理的咨询、预防和管理。
这是一项回顾性全国队列研究，纳入了 1999 年至 2009 年期间在荷兰连续两次单胎分娩的妇女。使用了一个纵向链接的全国队列，其中包含了荷兰随后的单胎分娩信息。主要结局指标为：产后出血（定义为阴道分娩或剖宫产术后≥1000ml）和人工胎盘剥离。我们计算了所有妇女产后出血和人工胎盘剥离的发生率和复发率，并按胎龄进行了分层。
在应用纳入和排除标准后，共研究了 359737 名妇女。第一次妊娠中，共有 5.4%的妇女发生产后出血，2.7%的妇女行人工胎盘剥离术。与无既往产后出血史的妇女相比，有产后出血史的妇女在后续妊娠中发生产后出血的风险显著升高（18%比 3.9%，调整后的优势比 4.5；95%置信区间 4.3-4.7）。与无既往人工胎盘剥离史的妇女相比，既往有过人工胎盘剥离史的妇女在第二次妊娠中行人工胎盘剥离术的风险仅为 1.4%。在第一次妊娠中于 32-37 周行人工胎盘剥离术的妇女复发风险最高（调整后的优势比 8.9；95%置信区间 7.2-11）。
有既往产后出血或人工胎盘剥离史的妇女复发风险增加。在第一次妊娠中分娩超过 32 周的妇女，这种风险的幅度最大。
