Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Int J Obstet Anesth. 2020 Aug;43:65-71. doi: 10.1016/j.ijoa.2020.03.001. Epub 2020 Mar 6.
Prior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually.
This retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks' and 24 weeks' gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models.
Charts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P <0.001) and pregnancy termination (P <0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P <0.001). Rates of peri-operative transfusion and re-admission for bleeding were <4%.
While blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation.
既往研究主要关注年手术量超过 1100 例的大容量中心的清宫术中出血情况。本研究旨在探讨年手术量少于 50 例的中心中，出血量与患者和手术特征之间的关系。
本回顾性队列研究经机构审查委员会批准，利用手术编码，在 50 个月期间确定了 14 周至 24 周妊娠龄行清宫术的患者。主要结局为估计出血量；次要结局为出血、输血和住院再入院。采用线性回归模型分析出血量与其他变量之间的关系。
共纳入 161 例患者的病历。中位估计出血量为 400 毫升（IQR 300 毫升），37%的患者出血量≥500 毫升。单变量分析显示，出血量增加与妊娠周数增加（P<0.001）和妊娠终止（P<0.001）相关。在多元线性回归模型中，两者均具有统计学意义。妊娠周数每增加一周，估计出血量平均增加 7.1%（95%CI 2.47%至 11.9%；P=0.003）。与术前胎儿死亡相比，因妊娠终止而进行清宫术的患者出血量增加 80.6%（95%CI 37.5%至 137.2%；P<0.001）。围手术期输血和因出血再入院的发生率<4%。
尽管低容量中心的出血量可能更大，但我们在孕中期清宫术后的输血和再入院率较低。
