School of Nursing, Oregon Health and Science University, Portland, Oregon.
William F. Connell School of Nursing, Boston College, Boston, Massachusetts.
J Midwifery Womens Health. 2020 Sep;65(5):609-620. doi: 10.1111/jmwh.13104. Epub 2020 Apr 14.
Postpartum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Predicting which laboring women are likely to have a PPH is an active area of research and a component of quality improvement bundles. The purpose of this study was to identify phenotypes of labor processes (ie, labors that have similar features, such as duration and type of interventions) in a cohort of women who had vaginal births, estimate the likelihood of PPH by phenotype, and analyze how maternal and fetal characteristics relate to PPH risk by phenotype.
This study utilized the Consortium for Safe Labor dataset (2002-2008) and examined term, singleton, vaginal births. Using 16 variables describing the labor and birth processes, a latent class analysis was performed to describe distinct labor process phenotypes.
Of 24,729 births, 1167 (4.72%) women experienced PPH. Five phenotypes best fit the data, reflecting labor interventions, duration, and complications. Women who had shorter duration of admission after spontaneous labor onset (admitted in latent or active labor) had the lowest rate of PPH (3.8%-3.9%). The 2 phenotypes of labor progress characterized by women who had complicated prolonged labors (spontaneous or induced) had the highest rate of PPH (8.0% and 12.0%, respectively). However, the majority of PPH (n = 881, 75%) occurred in the phenotypes with fewer complications. Prepregnancy body mass index did not predict PPH. Overall, the odds of PPH were highest among nulliparous women (odds ratio [OR], 1.52; 95% CI, 1.30-1.77), as well as Black women (OR, 1.39; 95% CI, 1.13-1.73) and Hispanic women (OR, 1.85; 95% CI, 1.56-2.20). Within phenotypes, maternal race and ethnicity, nulliparity, macrosomia, hypertension, and depression were associated with increased odds of PPH.
Women who were classified into a lower-risk labor phenotype and still experienced PPH were more likely to be nulliparous, a person of color, or diagnosed with hypertension.
产后出血（PPH）是产妇发病率和死亡率的重要原因。预测哪些分娩妇女可能会发生 PPH 是一个活跃的研究领域，也是质量改进方案的一个组成部分。本研究的目的是确定阴道分娩妇女的分娩过程表型（即具有相似特征的分娩，如持续时间和干预类型），根据表型估计 PPH 的可能性，并分析母体和胎儿特征如何通过表型与 PPH 风险相关。
本研究利用安全分娩联盟数据集（2002-2008 年），并检查了足月、单胎、阴道分娩。使用描述分娩和分娩过程的 16 个变量，进行潜在类别分析以描述不同的分娩过程表型。
在 24729 例分娩中，有 1167 例（4.72%）妇女发生 PPH。有 5 种表型最符合数据，反映了分娩干预、持续时间和并发症。自发分娩开始后入院时间较短（潜伏或活跃劳动时入院）的妇女发生 PPH 的几率最低（3.8%-3.9%）。劳动进展的 2 种表型特征是妇女经历了复杂的延长劳动（自然或诱导），PPH 的发生率最高（分别为 8.0%和 12.0%）。然而，大多数 PPH（n=881，75%）发生在并发症较少的表型中。孕前体重指数不能预测 PPH。总体而言，初产妇发生 PPH 的几率最高（比值比[OR]，1.52；95%CI，1.30-1.77），黑人和西班牙裔妇女也有较高的几率（OR，1.39；95%CI，1.13-1.73；OR，1.85；95%CI，1.56-2.20）。在表型内，产妇种族和民族、初产、巨大儿、高血压和抑郁与 PPH 几率增加相关。
被分类为低风险分娩表型的妇女仍发生 PPH，更有可能是初产妇、有色人种或被诊断为高血压。
