Feduniw Stepan, Warzecha Damian, Szymusik Iwona, Wielgos Miroslaw
Students Scientific Association at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
21st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland, Poland.
Ginekol Pol. 2020;91(1):38-44. doi: 10.5603/GP.2020.0009.
Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of at least 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includes literature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available prevention and treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies. The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelated and sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxis should be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atony which contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genital tract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect. However, carbetocin seems to be the most effective in certain situations. Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment should include uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterine tamponade should be considered due to its high effectiveness. Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment. It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood loss evaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future.
产后早期出血（EPH）是产后死亡的主要原因之一。它被定义为产后24小时内阴道分娩后失血至少500毫升或剖宫产术后失血1000毫升。以下论文包括文献综述，旨在评估产后早期出血（EPH）的发生率和预测因素。还评估了现有的预防和治疗方法。52项研究符合该研究的纳入标准。不同人群中EPH的确切发生率从1.2%到12.5%不等。产妇、妊娠相关、分娩相关和社会人口统计学风险因素似乎是EPH的重要预测因素。在这些情况下，应考虑适当的预防措施。然而，EPH可能在没有先前风险因素的情况下发生。EPH的主要原因是子宫收缩乏力，占产后出血（PPH）病例的80%。PPH的其他常见原因包括生殖道损伤、胎盘植入或凝血功能障碍。有趣的是，大多数宫缩剂似乎有类似的效果。然而，卡贝缩宫素在某些情况下似乎是最有效的。EPH的正确诊断是最重要的问题。治疗应针对病因。一线治疗应包括宫缩剂。如有需要，应立即进行手术干预，不过由于术前子宫压迫效果显著，应予以考虑。在医学模拟中心对医务人员进行培训是改善EPH治疗效果的一个重要因素。它有助于适应医院规程、改善团队协作、建立自信、更准确地评估失血量以及减轻压力感。系统培训的实施在未来会带来更好的结果。
