Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, Francie van Zijl Avenue, Cape Town, 7505, South Africa.
Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
BMC Pregnancy Childbirth. 2020 Jan 6;20(1):14. doi: 10.1186/s12884-019-2668-x.
Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome.
Women with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks' gestation or occurring up to 42 days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of ≥5 units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death.
The incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14].
Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.
产后大出血是导致产妇死亡的主要原因之一，占非洲产妇死亡人数的三分之一。本研究旨在评估主要产科出血的人群发生率、病因、处理方法和结局，并分析与产妇不良结局相关的危险因素。
2014 年 11 月至 2015 年 11 月期间，对南非开普敦都会东部地区符合世界卫生组织产妇接近死亡标准或因产后出血死亡的患者进行评估。主要产科出血定义为妊娠至少 20 周后或产后 42 天内发生的出血，并导致子宫切除、低血容量性休克或输注≥5 单位的浓缩红细胞。采用逻辑回归模型分析与不良结局相关的因素，不良结局定义为大量输血（≥8 单位浓缩红细胞）、子宫切除或死亡导致的主要产科出血。
主要产科出血的发生率为每 1000 例分娩 3 例，都会东部地区的大量输血发生率为每 10.000 例分娩 4 例（研究期间共有 32862 例分娩）。出血的主要原因是胎盘早剥 45/119（37.8%）、剖宫产并发症 29/119（24.4%）和子宫收缩乏力 13/119（10.9%）。119 例患者中 98/119（82.4%）给予催产素治疗，33/119（27.7%）行子宫切除术。输注的浓缩红细胞中位数为 6（四分位距 4-7），新鲜冰冻血浆中位数为 3（四分位距 2-4），比值为 1.7:1。剖宫产术与产妇不良结局独立相关：调整后的比值比为 4.01[95%可信区间 1.58，10.14]。
采用产妇接近死亡评估方法评估主要产科出血发现，胎盘早剥和剖宫产并发症是主要产科出血的主要原因。剖宫产术与不良结局相关。
