分娩住院期间使用子宫填塞和介入放射学程序。
Use of Uterine Tamponade and Interventional Radiology Procedures During Delivery Hospitalizations.
机构信息
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, Connecticut; and the Department of Obstetrics and Gynecology, Columbia University, New York, New York.
出版信息
Obstet Gynecol. 2020 Mar;135(3):674-684. doi: 10.1097/AOG.0000000000003722.
OBJECTIVE
To characterize use of uterine tamponade and interventional radiology procedures.
METHODS
This retrospective study analyzed uterine tamponade and interventional radiology procedures in a large administrative database. The primary outcomes were temporal trends in these procedures 1) during deliveries, 2) by hospital volume, and 3) before hysterectomy for uterine atony or delayed postpartum hemorrhage. Three 3-year periods were analyzed: 2006-2008, 2009-2011, and 2012-2014. Risk of morbidity in the setting of hysterectomy with uterine tamponade and interventional radiology procedures as the primary exposures was additionally analyzed in adjusted models.
RESULTS
The study included 5,383,486 deliveries, which involved 6,675 uterine tamponade procedures, 1,199 interventional radiology procedures, and 1,937 hysterectomies. Interventional radiology procedures increased from 16.4 to 25.7 per 100,000 delivery hospitalizations from 2006-2008 to 2012-2014 (P<.01), and uterine tamponade increased from 86.3 to 158.1 (P<.01). Interventional radiology procedures use was highest (45.0/100,000 deliveries, 95% CI 41.0-48.9) in the highest and lowest (8.9/100,000, 95% CI 7.1-10.7) in the lowest volume quintile. Uterine tamponade procedures were most common in the fourth (209.8/100,000, 95% CI 201.1-218.5) and lowest in the third quintile (59.8/100,000, 95% CI 55.1-64.4). Interventional radiology procedures occurred before 3.3% of hysterectomies from 2006 to 2008 compared with 6.3% from 2012 to 2014 (P<.05), and uterine tamponade procedures increased from 3.6% to 20.1% (P<.01). Adjusted risks for morbidity in the setting of uterine tamponade and interventional radiology before hysterectomy were significantly higher (adjusted risk ratio [aRR] 1.63, 95% CI 1.47-1.81 and aRR 1.75 95% CI 1.51-2.03, respectively) compared with when these procedures were not performed.
CONCLUSION
This analysis found that uterine tamponade and interventional radiology procedures became increasingly common over the study period, are used across obstetric volume settings, and in the setting of hysterectomy may be associated with increased risk of morbidity, although this relationship is not necessarily causal.
目的
描述子宫填塞和介入放射学程序的使用情况。
方法
本回顾性研究分析了大型行政数据库中的子宫填塞和介入放射学程序。主要结果是：1）分娩期间；2）按医院容量；3）在因子宫收缩乏力或产后出血延迟而行子宫切除术之前，这些程序的时间趋势。分析了三个 3 年期间：2006-2008 年、2009-2011 年和 2012-2014 年。在调整模型中，还分析了子宫填塞和介入放射学程序作为主要暴露因素的情况下，在子宫切除术时发生发病率的风险。
结果
这项研究包括 5383486 例分娩，涉及 6675 例子宫填塞术、1199 例介入放射学程序和 1937 例子宫切除术。从 2006-2008 年到 2012-2014 年，介入放射学程序从每 100000 例分娩医院的 16.4 例增加到 25.7 例（P<.01），子宫填塞术从 86.3 例增加到 158.1 例（P<.01）。介入放射学程序的使用率最高（45.0/100000 例分娩，95%CI 41.0-48.9），最低（8.9/100000 例，95%CI 7.1-10.7）。子宫填塞术在第五（209.8/100000 例，95%CI 201.1-218.5）和最低（59.8/100000 例，95%CI 55.1-64.4）五分位数中最常见。介入放射学程序在第三（3.3%）和第五（6.3%）分位中最常见，而在第三分位中最常见（20.1%）。从 2006 年到 2008 年，子宫切除术之前进行介入放射学程序的比例为 3.3%，而 2012 年至 2014 年为 6.3%（P<.05），子宫填塞术的比例从 3.6%增加到 20.1%（P<.01）。与未进行这些程序相比，在子宫填塞和介入放射学程序之前进行子宫切除术的发病率调整风险明显更高（调整风险比[aRR] 1.63，95%CI 1.47-1.81 和 aRR 1.75，95%CI 1.51-2.03）。
结论
本分析发现，在研究期间，子宫填塞和介入放射学程序的使用越来越普遍，在产科容量范围内使用，并且在子宫切除术时，可能与发病率增加相关，尽管这种关系并非必然因果关系。
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