Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Japan.
Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
J Matern Fetal Neonatal Med. 2022 Oct;35(20):3943-3947. doi: 10.1080/14767058.2020.1844654. Epub 2020 Nov 9.
Secondary postpartum hemorrhage (PPH) is defined as excessive vaginal blood loss occurring between 24 h and 6-12 weeks after birth. The incidence of secondary PPH varies from 0.2% to 3.0%, and the peak incidence ranges from 1 to 2 weeks postpartum. There is no clinical evidence regarding the cause of secondary PPH. Therefore, this study aimed to determine the predictive factors for secondary PPH in an Asian population.
A case-control study was performed. The clinical data of 25 secondary PPH patients who had been admitted to our hospital between June 2012 and January 2019 were obtained for this study. Control patients ( = 100) were selected from pregnant women who delivered at the hospital during the same period; they were matched to secondary PPH patients using propensity score matching to adjust for maternal age at delivery, parity, and the use of assisted reproductive technology (ART). A multiple logistic regression analysis was used to determine the predictive factors for secondary PPH.
The median maternal age was 34 years (range, 24-42 years); 85 (68.0%) women were nulliparous, 31 (24.8%) used ART, and 116 (92.8%) had term deliveries. Immediate PPH (adjusted odds ratio [OR], 2.84; 95% confidence interval [CI], 1.04-7.75) and manual removal of the placenta (adjusted OR, 6.14; 95% CI, 1.21-31.1) were associated with secondary PPH.
Increasing the awareness of the predictive factors for secondary PPH could play an important role in the recognition and treatment of postpartum morbidity.
继发性产后出血（PPH）定义为产后 24 小时至 6-12 周发生的过度阴道出血。继发性 PPH 的发生率为 0.2%至 3.0%，发病高峰为产后 1 至 2 周。关于继发性 PPH 的病因尚无临床证据。因此，本研究旨在确定亚洲人群中继发性 PPH 的预测因素。
采用病例对照研究。本研究纳入了 2012 年 6 月至 2019 年 1 月我院收治的 25 例继发性 PPH 患者的临床资料。对照组（n=100）为同期在我院分娩的孕妇，采用倾向评分匹配法与继发性 PPH 患者匹配，以调整产妇分娩年龄、产次和辅助生殖技术（ART）的使用。采用多因素 logistic 回归分析确定继发性 PPH 的预测因素。
产妇年龄中位数为 34 岁（范围：24-42 岁）；85 例（68.0%）为初产妇，31 例（24.8%）使用 ART，116 例（92.8%）为足月分娩。即时 PPH（调整优势比[OR]，2.84；95%置信区间[CI]，1.04-7.75）和胎盘手动剥离（调整 OR，6.14；95% CI，1.21-31.1）与继发性 PPH 相关。
提高对继发性 PPH 预测因素的认识，对于产后发病率的识别和治疗具有重要意义。
