Thies-Lagergren Li, Kvist Linda J, Gottvall Karin, Jangsten Elisabeth
Department of Midwifery Research - Reproductive, Perinatal and Sexual Health, Lund University, Sweden; Department of Obstetrics and Gynaecology, Helsingborg Lasarett, Sweden.
Department of Midwifery Research - Reproductive, Perinatal and Sexual Health, Lund University, Sweden.
Eur J Obstet Gynecol Reprod Biol. 2021 Mar;258:184-188. doi: 10.1016/j.ejogrb.2020.12.018. Epub 2021 Jan 5.
To explore diagnoses of postpartum haemorrhage following vaginal birth, in relation to socio-demographic and obstetrical data from women who gave birth at term, in Sweden, during the years 2005-2015.
A register-based cohort study was carried out, describing and comparing socio-demographic variables, obstetric variables and infant variables in 52 367 cases of diagnosed postpartum haemorrhage compared to 353 569 controls without a postpartum haemorrhage diagnosis. Postpartum hemorrhage was identified in The Swedish Medical Birth Register by ICD-10 code O72. Variables for maternal characteristics were dichotomized and used to calculate odds ratios to find possible explanatory variables for postpartum haemorrhage.
Between 2005 and 2015 there was no statistically significant decrease in diagnoses of postpartum haemorrhage after vaginal birth at term. Primiparity was associated with the highest risk and women birthing their fifth or subsequent child were associated with the lowest risk of postpartum hemorrhage. Increased maternal age (> 35 years) and/or obesity (BMI > 30) were associated with higher odds of postpartum haemorrhage. The risk of postpartum hemorrhage was 55 % higher when vaginal birth followed induction as compared to vaginal birth after spontaneous onset. Some of the factors known to be associated with postpartum haemorrhage were poorly documented in The Swedish Medical Birth Register.
Birthing women in a Swedish contemporary setting are, despite efforts to improve care, still at risk of birth being complicated by postpartum haemorrhage. Primiparity, increasing maternal age and/or obesity are found to provoke an increased risk and the reasons for these findings need to be further investigated. However, grand multi-parity did not increase the risk for postpartum hemorrhage. Codes for diagnoses require correct documentation in the birth records: only when local statistics are sound and correctly reported can intrapartum care be improved, and the incidence of postpartum haemorrhage reduced.
探讨2005年至2015年期间在瑞典足月分娩的妇女产后出血的诊断情况，并分析其与社会人口统计学和产科数据之间的关系。
开展了一项基于登记册的队列研究，描述并比较了52367例诊断为产后出血的病例与353569例未诊断为产后出血的对照病例的社会人口统计学变量、产科变量和婴儿变量。瑞典医疗出生登记册通过国际疾病分类第十版（ICD-10）代码O72识别产后出血。将产妇特征变量进行二分法处理，并用于计算比值比，以寻找产后出血可能的解释变量。
2005年至2015年期间，足月阴道分娩后产后出血的诊断率没有统计学上的显著下降。初产与最高风险相关，而生育第五个或更多孩子的妇女产后出血风险最低。产妇年龄增加（>35岁）和/或肥胖（体重指数>30）与产后出血几率较高相关。与自然发动后阴道分娩相比，引产后宫缩乏力导致的阴道分娩产后出血风险高55%。一些已知与产后出血相关的因素在瑞典医疗出生登记册中的记录不完善。
在瑞典现代环境下分娩的妇女，尽管努力改善护理，但仍有产后出血使分娩复杂化的风险。初产、产妇年龄增加和/或肥胖会增加风险，这些发现的原因需要进一步调查。然而，高经产并未增加产后出血的风险。诊断代码需要在出生记录中正确记录：只有当当地统计数据准确且报告正确时，才能改善产时护理并降低产后出血的发生率。
