Department of Obstetrics and Gynecology, Emek Medical Center, Yitzhak Rabin Boulevard 21, Afula, 1834111, Israel.
Department of Obstetrics and Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel.
Sci Rep. 2020 Dec 9;10(1):21546. doi: 10.1038/s41598-020-77799-0.
Postpartum hemorrhage (PPH) is defined as blood loss of ≥ 500-1000 ml within 24 h after delivery. Yet, assessment of blood loss is imprecise. The present study aimed to profile the hemoglobin (Hb) drop after vaginal delivery with versus without PPH. This was a secondary analysis of a prospective cohort study of women who delivered vaginally. Women were included if complete blood counts (CBC) before and after delivery were taken until stabilization (N = 419). Women were categorized into the PPH group and controls, for whom post-delivery CBCs were performed due to indications unrelated to bleeding. The PPH patients were then classified as either overt or occult PPH (symptoms related to hypovolemia without overt bleeding) subgroups. The primary endpoint was mean Hb drop after delivery. One hundred and ten (26%) and 158 (38%) women presented with overt PPH or occult PPH, respectively; 151 (36%) women were included in the control group. Mean Hb decrease from baseline was 3.0 ± 1.6, 2.0 ± 1.4 and 0.9 ± 1.0 g/dl, respectively (p < 0.0001). In all groups, maximal rate of Hb decline was in the first 6-12 h postpartum and plateaued after 24-48 h. At 48 h post-delivery, 95% and 86% of women who had dropped to Hb ≤ 9.5 and < 7 g/dl, respectively, reached those thresholds. Taken together, an Hb decrease ≥ 2 g/dl was consistent with PPH diagnosis and should be followed for at least 48 h after delivery.
产后出血 (PPH) 定义为分娩后 24 小时内出血量≥500-1000ml。然而，出血量的评估并不精确。本研究旨在描述有无 PPH 的阴道分娩后血红蛋白 (Hb) 下降情况。这是一项对阴道分娩妇女进行的前瞻性队列研究的二次分析。如果分娩前后的全血细胞计数 (CBC) 直到稳定后才进行 (N=419)，则将妇女纳入研究。将妇女分为 PPH 组和对照组，对照组因与出血无关的原因进行产后 CBC。然后将 PPH 患者分为显性或隐性 PPH（与低血容量相关的症状，无显性出血）亚组。主要终点是产后平均 Hb 下降量。分别有 110 名 (26%) 和 158 名 (38%) 妇女出现显性 PPH 或隐性 PPH；151 名 (36%) 妇女被纳入对照组。与基线相比，平均 Hb 下降量分别为 3.0±1.6、2.0±1.4 和 0.9±1.0 g/dl（p<0.0001）。在所有组中，Hb 下降最快的时间均在产后 6-12 小时，24-48 小时后趋于平稳。产后 48 小时，分别有 95%和 86%的 Hb 下降至≤9.5 和<7 g/dl 的妇女达到了这些阈值。总之，Hb 下降≥2 g/dl 与 PPH 诊断一致，应在产后至少 48 小时内进行随访。
